The use of balanced HES 130/0.42 during complex cardiac surgery; effect on blood coagulation and fluid balance: a randomized controlled trial

Abstract

After complex cardiac surgery, the use of balanced 6% HES130/0.42 solution for CPB circuit priming did not impair haemostasis measured by ROTEM®, but it increased the need for transfusions. Fluid balance after CPB was less positive in the HES group, but, on the 1POM, it was comparable between the groups.

2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery

“…Priming Solutions. In studies addressing the impact of the type of priming solution on postoperative bleeding and blood product transfusion as secondary end points, a comparison of 6% HES 130/0.4 (mean molecular weight 130 kDa; degree of substitution) with 6% HES 400/0.7 prime with gelatine prime, 190 albumin prime 191,192 or Ringer's acetate 193 was made. There was no effect of 6% HES 130/0.4 on blood loss or transfusion requirements.…”

2014 Consensus conference on viscoelastic test–based transfusion guidelines for early trauma resuscitation

“…72 However, GPIIb-IIIa inhibitors will be detected. Because viscoelastic tests work by activating plasma coagulation, which in turn recruits platelets with the strong platelet activator thrombin, problems in the normal weak platelet activation pathways may not be detected.…”

Choice of fluid type: physiological concepts and perioperative indications

“…In an RCT, there were no differences in blood-coagulation parameters or postoperative bleeding between the use of Ringer's acetate or balanced HES 130/0.4 as the priming solution. 56 The HES group required more postoperative blood transfusion, albeit the study was not powered to prove this effect. 56 Moreover, a large dose of HES 130/0.4 did not reveal differences in postoperative blood loss and bleeding after Table 2 Overview of randomized controlled studies with perioperative blood loss as primary end point.…”

“…56 The HES group required more postoperative blood transfusion, albeit the study was not powered to prove this effect. 56 Moreover, a large dose of HES 130/0.4 did not reveal differences in postoperative blood loss and bleeding after Table 2 Overview of randomized controlled studies with perioperative blood loss as primary end point. aPTT, activated partial thromboplastin time; CABG, coronary artery bypass graft surgery; CT, clotting time; HES, hydroxyethyl starch; INR, international normalized ratio; MA, maximum amplitude; MCF, maximum clot firmness; PRBC, packed red blood cell; PT, prothrombin time; TEG, thromboelastography; TEM, thromboelastometry.…”