Comparison of the effects of gelatin, Ringer's solution and a modern hydroxyl ethyl starch solution after coronary artery bypass graft surgery : cardiovascular topic

Alavi, Seyed Mostafa; Baharvand-Ahmadi, Babak; Baharestani, Bahador; Babaei, Tooraj

doi:10.5830/cvja-2012-026

Cited by 29 publications

(26 citation statements)

References 14 publications

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“…[ 30 ] and Alavi et al . [ 53 ] appear most relevant for heterogeneity, but these results pointed in the same direction as those from most other trials. Pentastarch 0.45 was as effective as albumin (SMD, 0.18; 95% CI, −0.17, 0.54; P = 0.31) and gelatin (SMD, −0.22; 95% CI, −0.53, 0.10; P = 0.18), whereas pentastarch 0.5 was inferior to albumin (SMD, 0.57; 95% CI, 0.10, 1.04; P = 0.02) (Additional file 6 ).…”

Section: Resultssupporting

confidence: 63%

“…Thus, we ultimately included in our meta-analysis 51 publications describing 49 clinical studies composed of an aggregate of 3,439 patients. Of these 49 studies, 30 [ 11 - 42 ] were unblinded, 10 [ 43 - 52 ] were partly blinded and 9 were completely blinded [ 53 - 61 ]. The duration of follow-up covered a wide range, from 2 hours to 30 days.…”

Section: Resultsmentioning

confidence: 99%

“…In one study [ 42 ], the researchers reported that equal volumes of red blood cells were required, without regard to whether volume expansion was performed with tetrastarch or crystalloids. In two studies, the investigators reported that more packed red blood cells were transfused with tetrastarch [ 51 , 53 ].…”

Section: Resultsmentioning

confidence: 99%

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The impact of hydroxyethyl starches in cardiac surgery: a meta-analysis

2014

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IntroductionRecent studies in septic patients showed that adverse effects of hydroxyethyl starches (HESs) possibly outweigh their benefits in severely impaired physiological haemostasis. It remains unclear whether this also applies to patient populations that are less vulnerable. In this meta-analysis, we evaluated the impact of various HES generations on safety and efficacy endpoints in patients undergoing cardiac surgery.MethodsWe searched the PubMed, Embase and Cochrane Central Register of Controlled Trials databases for randomised controlled trials (RCTs) in the English or German language comparing the use of HES to any other colloid or crystalloid during open heart surgery.ResultsBlood loss and transfusion requirements were higher for older starches with mean molecular weights more than 200 kDa compared to other volume substitutes. In contrast, this effect was not observed with latest-generation tetrastarches (130/0.4), which performed even better when compared to albumin (blood loss of tetrastarch versus albumin: standardised mean difference (SMD), −0.34; 95% CI, −0.63, −0.05; P = 0.02; versus gelatin: SMD, −0.06; 95% CI, −0.20, 0.08; P = 0.39; versus crystalloids: SMD, −0.05; 95% CI, −0.20, 0.10; P = 0.54). Similar results were found for transfusion needs. Lengths of stay in the intensive care unit or hospital were significantly shorter with tetrastarches compared to gelatin (intensive care unit: SMD, −0.10; 95% CI, −0.15, −0.05; P = 0.0002) and crystalloids (hospital: SMD, −0.52; 95% CI, −0.90, −0.14; P = 0.007).ConclusionsIn this meta-analysis of RCTs, we could not identify safety issues with tetrastarches compared with other colloid or crystalloid solutions in terms of blood loss, transfusion requirements or hospital length of stay in patients undergoing cardiac surgery. The safety data on coagulation with older starches raise some issues that need to be addressed in future trials.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0656-0) contains supplementary material, which is available to authorized users.

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Section: Resultssupporting

confidence: 63%

Section: Resultsmentioning

confidence: 99%

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The impact of hydroxyethyl starches in cardiac surgery: a meta-analysis

2014

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“…The results of the studies were similar to those when HES solutions were used for priming. There were no adverse effects documented on postoperative coagulation parameters and postoperative renal functions [13,14]. …”

Section: Discussionmentioning

confidence: 99%

Hydroxyethyl starch 6%, 130/0.4 vs. a balanced crystalloid solution in cardiopulmonary bypass priming: a randomized, prospective study

Gürbüz

Durukan

Salman

et al. 2013

J Cardiothorac Surg

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BackgroundSince the advent of cardiopulmonary bypass, many efforts have been made to avoid the complications related with it. Any component of the pump participates in occurrence of these adverse events, one of which is the type of prime solution. In this study, we aimed to compare the effects of 6% hydroxyethyl starch 130/0.4 with a commonly used balanced electrolyte solution on postoperative outcomes following coronary bypass surgery.MethodsTwo hundred patients undergoing elective coronary bypass surgery were prospectively studied. The patients were randomized in to two groups. First group received a balanced electrolyte solution and the second group received 6% hydoxyethyl starch 130/0.4 as prime solution. The postoperative outcomes of the patients were studied.ResultsThe mean age of the patients was 61.81 ± 10.12 in the crystalloid group whereas 61.52 ± 9.29 in the HES group. There were 77 male patients in crystalloid group and 74 in HES group. 6% hydroxyethyl starch 130/0.4 did not have any detrimental effects on renal and pulmonary functions. The intensive care unit stay and postoperative hospital length of stay were shorter in hydroxyethyl starch group (p < 0.05 for each). Hydroxyethyl starch did not increase postoperative blood loss, amount of blood and fresh frozen plasma used, but it decreased platelet concentrate requirement. It did not have any effect on occurrence of post-coronary bypass atrial fibrillation (p > 0.05).Conclusions6% hydroxyethyl starch 130/0.4 when used as a prime solution did not adversely affect postoperative outcomes including renal functions and postoperative blood transfusion following coronary bypass surgery.

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“…LMW HES has been shown to be safe in cardiovascular surgery[ 67 68 69 70 ] and liver transplant. [ 71 ] In major abdominal surgeries Staikou et al .…”

Section: Clinical Implications Of Tissue Accumulationmentioning

confidence: 99%

Hydroxyeyhyl starch: Controversies revisited

Datta

Nair

Pandey

et al. 2014

J Anaesthesiol Clin Pharmacol

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Hydroxyethyl starch (HES) family has been one of the cornerstones in fluid management for over four decades. Recent evidence from clinical studies and meta-analyses has raised few concerns about the safety of these fluids, especially in certain subpopulations of patients. High-quality clinical trials and meta-analyses have emphasized nephrotoxic effects, increased risk of bleeding, and a trend toward higher mortality in these patients after the use of HES solutions. Scientific evidence was derived from international guidelines, aggregated research literature, and opinion-based evidence was obtained from surveys and other activities (e.g., internet postings). On critical analysis of the current data available, it can be summarized that further large scale trials are still indicated before HES can be discarded.

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Comparison of the effects of gelatin, Ringer's solution and a modern hydroxyl ethyl starch solution after coronary artery bypass graft surgery : cardiovascular topic

Cited by 29 publications

References 14 publications

The impact of hydroxyethyl starches in cardiac surgery: a meta-analysis

The impact of hydroxyethyl starches in cardiac surgery: a meta-analysis

Hydroxyethyl starch 6%, 130/0.4 vs. a balanced crystalloid solution in cardiopulmonary bypass priming: a randomized, prospective study

Hydroxyeyhyl starch: Controversies revisited

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