Fueling the Debate on Albumin After Cardiac Surgery

Mwaura, Lucy; Vuylsteke, Alain

doi:10.1053/j.jvca.2019.04.030

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…This potential volumesparing effect of colloids is perceived as advantageous in preventing fluid overload complications such as pulmonary edema and right ventricular impairment; nevertheless, it is variably supported by the published literature. [39][40][41] Additionally, albumin may also function as an antioxidant to reduce inflammation, 42 may play a role in preserving platelet number and function, 43 and through its action as a nitric oxide scavenger may decrease nitric oxide mediated vasodilation. 44 These effects may be of particular benefit during and after CPB.…”

Section: Methodsmentioning

confidence: 99%

Albumin in adult cardiac surgery: a narrative review

Hanley

Callum

Karkouti

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Intravascular fluids are a necessary and universal component of cardiac surgical patient care. Both crystalloids and colloids are used to maintain or restore circulating plasma volume and ensure adequate organ perfusion. In Canada, human albumin solution (5% or 25% concentration) is a colloid commonly used for this purpose. In this narrative review, we discuss albumin supply in Canada, explore the perceived advantages of albumin, and describe the clinical literature supporting and refuting albumin use over other fluids in the adult cardiac surgical population. Source We conducted a targeted search of PubMed, Embase, Medline, Web of Science, ProQuest Dissertations and Theses Global, the Cochrane Central Register of Controlled trials, and the Cochrane Database of Systematic Reviews. Search terms included albumin, colloid, cardiac surgery, bleeding, hemorrhage, transfusion, and cardiopulmonary bypass. Principal findings Albumin is produced from fractionated human plasma and imported into Canada from international suppliers at a cost of approximately $21 million CAD per annum. While it is widely used in cardiac surgical patients across the country, it is approximately 30-times more expensive than equivalent doses of balanced crystalloid solutions, with wide inter-institutional variability in use and no clear association with improved outcomes. There is a general lack of high-quality evidence for the superiority of albumin over crystalloids in this patient population, and conflicting evidence regarding safety. Conclusions In cardiac surgical patients, albumin is widely utilized despite a lack of high-quality evidence supporting its efficacy or safety. A well-designed randomized controlled trial is needed to clarify the role of albumin in cardiac surgical patients. Re ´sumeÓbjectif Les liquides intravasculaires sont une composante ne´cessaire et universelle des soins aux patients de chirurgie cardiaque. Les cristalloı¨des et les colloı¨des sont utilise´s pour maintenir ou restaurer le volume plasmatique en circulation et assurer une perfusion ade´quate des organes. Au Canada, les solutions d'albumine humaine (concentration de 5 % ou 25 %) constituent un colloı¨de couramment utilise´a`cette fin. Dans

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Section: Methodsmentioning

confidence: 99%

Albumin in adult cardiac surgery: a narrative review

Hanley

Callum

Karkouti

et al. 2021

Can J Anesth/J Can Anesth

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“…The intervention was also associated with a decreased median overall dose of norepinephrine (median: 19 vs. 47, P =0.025) and a shorter median time to cessation of norepinephrine (median: 17 h vs. 28 h, P =0.002). [ 13 , 58 , 59 ] Another retrospective study by Thang et al [ 60 ] included 8136 cardiac surgical patients and showed that 4444 (54.6%) patients who received HSA during the first 24 h of intensive care unit admission had significantly lower adjusted mortality than patients who did not (OR, 0.68; 95% CI, 0.48–0.97; P <0.05). As a result, there is a growing interest in the utility of HSA to avoid over-resuscitation and an excessive positive fluid balance in patients undergoing cardiac surgery.…”

Section: Section 1: Volume Replacementmentioning

confidence: 99%

Expert consensus on the use of human serum albumin in adult cardiac surgery

Fei

Huang

et al. 2023

Chinese Medical Journal

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“… 1 However, the optimal fluid to administer remains controversial with significant variation in clinical and institutional practices. 2 While more than half of cardiovascular anaesthesiologists and cardiac surgeons in the US reported that balanced crystalloid solutions are their preferred first line choice for volume expansion in cardiac surgical patients not experiencing significant blood loss, over one third still considered albumin to be their first fluid choice. 3 This continued routine use of albumin is rooted in firm belief among some practitioners that albumin is a better fluid expander than crystalloids and that it has protective effects on the endothelial glycocalyx.…”

Section: Introductionmentioning

confidence: 99%

Reduce intraoperative albumin utilisation in cardiac surgical patients: a quality improvement initiative

Savadjian,

Taicher,

et al. 2024

BMJ Open Qual

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BackgroundAlbumin continues to be used routinely by cardiac anaesthesiologists perioperatively despite lack of evidence for improved outcomes. The Multicenter Perioperative Outcomes Group (MPOG) data ranked our institution as one of the highest intraoperative albumin users during cardiac surgery. Therefore, we designed a quality improvement project (QIP) to introduce a bundle of interventions to reduce intraoperative albumin use in cardiac surgical patients.MethodsOur institutional MPOG data were used to analyse the FLUID-01-C measure that provides the number of adult cardiac surgery cases where albumin was administered intraoperatively by anaesthesiologists from 1 July 2019 to 30 June 2022. The QIP involved introduction of the following interventions: (1) education about appropriate albumin use and indications (January 2021), (2) email communications reinforced with OR teaching (March 2021), (3) removal of albumin from the standard pharmacy intraoperative medication trays (April 2021), (4) grand rounds presentation discussing the QIP and highlighting the interventions (May 2021) and (5) quarterly provider feedback (starting July 2021). Multivariable segmented regression models were used to assess the changes from preintervention to postintervention time period in albumin utilisation, and its total monthly cost.ResultsAmong the 5767 cardiac surgery cases that met inclusion criteria over the 3-year study period, 16% of patients received albumin intraoperatively. The total number of cases that passed the metric (albumin administration was avoided), gradually increased as our interventions went into effect. Intraoperative albumin utilisation (beta=−101.1, 95% CI −145 to −56.7) and total monthly cost of albumin (beta=−7678, 95% CI −10712 to −4640) demonstrated significant decrease after starting the interventions.ConclusionsAt a single academic cardiac surgery programme, implementation of a bundle of simple and low-cost interventions as part of a coordinated QIP were effective in significantly decreasing intraoperative use of albumin, which translated into considerable costs savings.

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Fueling the Debate on Albumin After Cardiac Surgery

Cited by 7 publications

References 11 publications

Albumin in adult cardiac surgery: a narrative review

Albumin in adult cardiac surgery: a narrative review

Expert consensus on the use of human serum albumin in adult cardiac surgery

Reduce intraoperative albumin utilisation in cardiac surgical patients: a quality improvement initiative

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