title: The effect of intraoperative 6% balanced hydroxyethyl starch (130/0.4) during cardiac surgery on transfusion requirements.
abstract: OBJECTIVE
  To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative fluid therapy.
  
  
  METHODS
  Data were obtained retrospectively from medical records and perfusion charts. Matching based on propensity scores was used to adjust for potential confounders.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass.
  
  
  METHODS
  Allocation to one of the study groups according to whether balanced HES or balanced crystalloids was used for pump prime and intraoperative fluid therapy.
  
  
  RESULTS
  240 propensity-matched patients were retained for final analyses. Forty-eight patients (40%) of the colloid group and 28 patients (23.3%) of the crystalloid group received blood products, with an odd ratio (95% CI) of 2.1(1.2-3.8 (P=0.009). After bypass HES patients had lower hemoglobin levels (8.4 [1.3] gr/dL vs 9.6 [2] gr/dL; P<0.001) and a higher cumulative chest drain output after 3 hours (180 [210] mL vs 140 [100] mL, P<0.001]. Heparinase thromboelastogram (TEG®) showed longer K times (2.5[1.1] vs 1.6[0.8], P<0.001) and lower maximal amplitudes (55.1[12.5] vs 63.4[9.8], P=0.008).
  
  
  CONCLUSIONS
  HES patients required more transfusions, owing to greater hemodilution, HES-induced clotting disturbances, and bleeding.
authors.affiliation: Anesthetist, Department of Anesthesia and Intensive Care Medicine, CHU of Liege. Domaine Universitaire du Sart Tilman. Avenue de l'hopital Bat. B35. 4000 Liege. Belgium. Electronic address: G.Hans@chu.ulg.ac.be.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hans
authors.affiliation: Anesthetist, Department of Anesthesia and Intensive Care Medicine, CHU of Liege. Domaine Universitaire du Sart Tilman. Avenue de l'hopital Bat. B35. 4000 Liege. Belgium.
authors.forename: Didiier
authors.initials: D
authors.lastname: Ledoux
authors.affiliation: Anesthetist, Department of Anesthesia and Intensive Care Medicine, CHU of Liege. Domaine Universitaire du Sart Tilman. Avenue de l'hopital Bat. B35. 4000 Liege. Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Roediger
authors.affiliation: Anesthetist, Department of Anesthesia and Intensive Care Medicine, CHU of Liege. Domaine Universitaire du Sart Tilman. Avenue de l'hopital Bat. B35. 4000 Liege. Belgium.
authors.forename: Marie Bernard
authors.initials: MB
authors.lastname: Hubert
authors.affiliation: Clinical Perfusionnist, Department of Cardiovascular Surgery, CHU of Liege. Domaine Universitaire du Sart Tilman. Avenue de l'hopital Bat. B35. 4000 Liege. Belgium.
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Koch
authors.affiliation: Anesthetist, Department of Anesthesia and Intensive Care Medicine, CHU of Liege. Domaine Universitaire du Sart Tilman. Avenue de l'hopital Bat. B35. 4000 Liege. Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Senard
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007430:Intraoperative Care / Q000379:methods*; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D010952:Plasma Substitutes / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes
keywords: Hydroxyethyl starch; bleeding; cardiac surgery; cardiopulmonary bypass; crystalloid; transfusion