Albumin—Beyond Fluid Replacement in Cardiopulmonary Bypass Surgery

Moret, E.; Jacob, Matthias; Ranucci, Marco; Schramko, Alexey

doi:10.1177/1089253214535667

Cited by 23 publications

(25 citation statements)

References 52 publications

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“…This modification of the procedure also improved microcirculatory flow in patients undergoing open heart surgery (62). It is important to note that current circuit priming strategies, especially in pediatrics, remain unsettled over the use of albumin, synthetic colloid suspensions, packed RBC units, fresh frozen plasma (FFP), or some combination therein, due to clinical concerns of hemodilution, inflammation, bleeding, and cost effectiveness (66)(67)(68)(69)(70). Though as indicated in this review, sublethal mechanical blood trauma likely plays a role in some of these complications.…”

Section: Protection Of Red Blood Cells From Mechanical Traumamentioning

confidence: 99%

Mechanical Blood Trauma in Assisted Circulation: Sublethal RBC Damage Preceding Hemolysis

et al. 2016

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After many decades of improvements in mechanical circulatory assist devices (CADs), blood damage remains a serious problem during support contributing to variety of adverse events, and consequently affecting patient survival and quality of life. The mechanisms of cumulative cell damage in continuous-flow blood pumps are still not fully understood despite numerous in vitro, in vivo, and in silico studies of blood trauma. Previous investigations have almost exclusively focused on lethal blood damage, namely hemolysis, which is typically negligible during normal operation of current generation CADs. The measurement of plasma free hemoglobin (plfHb) concentration to characterize hemolysis is straightforward, however sublethal trauma is more difficult to detect and quantify since no simple direct test exists. Similarly, while multiple studies have focused on thrombosis within blood pumps and accessories, sublethal blood trauma and its sequelae have yet to be adequately documented or characterized. This review summarizes the current understanding of sublethal trauma to red blood cells (RBCs) produced by exposure of blood to flow parameters and conditions similar to those within CADs. It also suggests potential strategies to reduce and/or prevent RBC sublethal damage in a clinically-relevant context, and encourages new research into this relatively uncharted territory.

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Section: Protection Of Red Blood Cells From Mechanical Traumamentioning

confidence: 99%

Mechanical Blood Trauma in Assisted Circulation: Sublethal RBC Damage Preceding Hemolysis

et al. 2016

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“…Albumin is widely used in clinical practice and it is known for some physiological properties other than the maintenance of oncotic pressure, such as antioxidant effects and positive effects on vessel wall integrity . Albumin interacts with the glycocalyx and reduces vascular permeability, thus enhancing microcirculatory function in critically ill patients . Albumin can restore endothelial response to acetylcholine …”

Section: Introductionmentioning

confidence: 99%

Economic model of albumin infusion in septic shock: The EMAISS study

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Ghout

Ropers

et al. 2020

Acta Anaesthesiol Scand

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Background The cost‐effectiveness of albumin‐based fluid support in patients with septic shock is currently unknown. Methods In a simulation study, we compared standard medical practice and systematic 20% albumin infusion. The study population consisted of patients with septic shock admitted to one of the 28 ICUs belonging to the Cub‐Réa regional database between 1 January 2014 and 31 December 2016. Cost estimates were based on French diagnosis‐related groups and fixed daily prices. Estimation of mortality reduction relied on ALBIOS trial data documenting a Risk Ratio of 0.87 in a non‐preplanned subgroup of patients with septic shock. Life expectancy was estimated with follow up data of 184 patients with septic shock admitted in the year 2000 in the same ICUs. Several sensitivity analyses were performed including a one‐way Deterministic Sensitivity Analysis (DSA) and a Probabilistic multivariate Sensitivity Analysis (PSA). Results About 6406 patients were included. In the base‐case scenario, the mean live years gained with albumin was 0.49. The mean extra cost of using albumin was €480 per year. The cost per year gained was €974. Sensitivity analyses confirmed the robustness of the results. The probability of albumin being cost‐effective was 95% and 97% for a threshold fixed at €20 000 and €30 000 per life‐year saved, respectively. Conclusion Based on the risk reduction observed in the septic shock subgroup analysis of the ALBIOS dataset, the application of the ALBIOS trial results to Cub‐Réa data may suggest that albumin infusion is likely cost‐effective in septic shock.

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“…Albumin leakage due to alteration of the sieving efficient would be a serious consequence for cardiopulmonary bypass surgeries. Moret et al reported that lower albumin concentration induced hypotension due to lower colloid osmotic pressure (24). Testing is therefore needed to confirm that no albumin leakage occurs.…”

Section: Discussionmentioning

confidence: 99%

Prospects for Clinical Applications of Polymer-Coated Haemoconcentrator on Extracorporeal Circuit in Cardiopulmonary Bypass Surgeries

et al. 2016

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Purpose Extracorporeal circulation circuits used in cardiopulmonary bypass surgeries are increasingly being coated with polymer materials to reduce the thrombogenicity of extracorporeal devices. However, a haemoconcentrator, which corrects haematocrit and electrolyte imbalances, is not coated with polymers. In this study, we sought to assess the filtration performance of polymer-coated haemoconcentrators in order to obtain insight into their prospects for use in clinical applications. Methods In vitro experiments were performed to evaluate the water pressure and flow properties of polymer-coated haemoconcentrators by comparing 3 polymer-coated haemoconcentrators with 3 non-coated haemoconcentrators. The cross-sectional surfaces of both types of haemoconcentrators were observed using a scanning electron microscope (SEM). Results The slopes of the regression lines for estimating the filtrated fluid flow as a function of the transmembrane pressure were 6.286 ± 0.320 for polymer-coated haemoconcentrators and 3.712 ± 0.170 for non-coated haemoconcentrators. These slopes were found to be significantly different and indicate that the filtration velocity is enhanced in polymer-coated haemoconcentrators over that in non-coated haemoconcentrators. However, the hollow fibre damage observed by SEM was not shown to contribute to higher filtration flow in the polymer-coated haemoconcentrator. Taking these results into consideration, we hypothesise that a polymer coating makes a foreign surface on a hollow fibre slippery, owing to the hydrophobicity of the polymer, thereby enhancing the velocity of the filtration. Conclusions The results of this preliminary investigation suggest that a polymer coating can enhance the filtration performance of a haemoconcentrator and that polymer-coated haemoconcentrators might be useful in clinical applications.

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Albumin—Beyond Fluid Replacement in Cardiopulmonary Bypass Surgery

Cited by 23 publications

References 52 publications

Mechanical Blood Trauma in Assisted Circulation: Sublethal RBC Damage Preceding Hemolysis

Mechanical Blood Trauma in Assisted Circulation: Sublethal RBC Damage Preceding Hemolysis

Economic model of albumin infusion in septic shock: The EMAISS study

Prospects for Clinical Applications of Polymer-Coated Haemoconcentrator on Extracorporeal Circuit in Cardiopulmonary Bypass Surgeries

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