Hemostatic effects of three colloid plasma substitutes for priming solution in cardiopulmonary bypass

Abstract

We conclude that, with human albumin the golden standard, 2.5% hydroxyethyl starch is a suitable colloid plasma substitute to be used as priming solution in an extracorporeal circuit as well as peri- and postoperative infusion fluid, reasonably well maintaining hemostasis.

Correspondence

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We were concerned about the findings of Tigchelaar et al in which ADP-induced platelet dysfunction was reportedly seen following cardiopulmonary bypass [1]. We are glad that they found HES to be a cost-effective plasma expander which neither caused bleeding nor perceptibly worsened platelet function, thus confirming previous work [2].

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Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

“…The similar effect of HES 130/0.4 and gelatin on postoperative blood loss has already been demonstrated (Van der Linden et al 2005). Moreover, the modern HES and gelatin solutions have been proven safe regarding bleeding in comparison with Ringer's or albumin solutions (Tigchelaar et al 1997, Boldt et al 2009). …”

Influência do emprego de albumina humana sobre a função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

“…No entanto, este fato foi estudado por Boks e col. de forma aleatória, não sendo observada diminuição da resistência dos oxigenadores ao fluxo da CEC, nem diminuição da ativação plaquetária, quando o uso da adição de albumina no perfusato foi comparado ao uso isolado de solução cristalóide. 18 Este fato mostra que a adição de albumina em indivíduos normais se mantém questionável, embora diminua a viscosidade do sangue e ajude a manter uma pressão coloidosmótica melhor durante a CEC 19 . A existên-cia de um impacto significativo da hipoalbuminemia no pré-operatório sobre a mortalidade e a morbidade no pós-operatório de cirurgia cardíaca 20 justificaria o seu uso, por outro lado, em casos selecionados.…”

“…However, this fact has been randomly studied by Boks et al and no oxygenators resistance to CPB flow decrease or decreased platelet activation has been observed with the addition of albumin to perfusate, as compared to crystalloid solution alone 18 . This shows that the addition of albumin for normal individuals is still questionable, although decreasing blood viscosity and helping maintaining better colloidosmotic pressure during CPB 19 . On the other hand, the existence of a significant preoperative hypoalbuminemia on postoperative heart surgery morbidity and mortality 20 would justify its use in selected cases.…”