O-59 Comparison of albumin 5%, hydroxyethyl starch 130/0.4 (6%) and Ringer-Lactate for volume replacement during cardiac surgery

Abstract

Introduction. There is an ongoing debate about the optimal priming solution for cardiopulmonary bypass (CPB). We compared hydroxyethyl starch (HES) 130/0.4 (6%), Ringer-Lactate (RL) and human albumin (HA) 5% for volume replacement during and after cardiac surgery. The effects on postoperative blood loss and clot formation time (CFT-Intem) measured by throm-boelastography were examined. Method. Two hundred and forty patients were included in this double blind, randomized, controlled trial. They were randomly assigned to either receive HES (n=80), HA 5% (n=80) or RL (n= 80). Study solutions were administered in 250 mL bottles and blinding was ensured through the use of specially prepared opaque masking sheets. 1.5 L of solution was used for CPB prime. Intra- and postoperative fluid management was guided by central venous pressure and clinical judgement. Patients received up to 50 ml kg-1 d-1 of the respective study solutions. RL was administered for additional volume replacement. Statistical analysis was performed using two-way analysis of variance. P<0.05 was considered significant. Results. Cumulative blood loss over 24 hours after surgery was equal between groups. Patients in the RL group received significantly more study solution compared to HES and HA 5% patients (P<0.0001). The 24 hour fluid balance was least positive in the HA 5% group in relation to the other two groups (P<0.0001). On arrival in the ICU, CFT-Intem values were significantly different (P<0.0001) between groups with the highest values being detected in the HES group and the lowest in the RL group. Twenty-four hours after surgery, the HA 5% group showed significantly higher values than patients of the RL (P<0.0001) and the HES group (P=0.0042). No significant difference was found between the HES and the RL group (P>0.1929). Discussion. Both colloids induced prolongation of CFT-Intem. However, 24 hours after surgery, it only persisted in the HA 5% group. Thus, both colloids might negatively affect coagulation. In contrast, RL did not influence coagulation parameters.