Pro: Third-Generation Hydroxyethyl Starch Solution Is Safe and Effective for Plasma Volume Expansion During Cardiac Surgery

Revisiting the use of hydroxyethyl starch solutions in equine fluid therapy

“…Proponents of HES maintain that there are positive effects of rapid volume expansion achieved with small volume of fluids and the decreased risk of fluid overload in comparison to fluid resuscitation with crystalloids (McConell et al 2018). In contrast, opposition to HES use is related to the risk of induction of acute kidney injury leading to requirement for RRT, the potential for coagulopathies and the risk for extra‐renal tissue accumulation (Myburgh et al 2012; Perner et al 2012; Sacchet‐Cardozo et al 2018).…”

Response: Postoperative Acute Kidney Injury and Blood Product Transfusion After Synthetic Colloid Use During Cardiac Surgery

“…2 Abnormal bleeding occurs in more than 10% of patients undergoing cardiac surgery. 15 First-generation HES solutions are associated with increased bleeding and coagulopathy; however, recent evidence suggests that the effects of modern third-generation HES solutions on coagulation are similar to those of albumin and crystalloids in patients undergoing surgery. 15 Data from several large studies have demonstrated that third-generation HES solutions have greatly improved and do not increase risk of kidney injury, blood loss, transfusion, coagulopathy, or mortality in cardiac surgical patients.…”

“…15 First-generation HES solutions are associated with increased bleeding and coagulopathy; however, recent evidence suggests that the effects of modern third-generation HES solutions on coagulation are similar to those of albumin and crystalloids in patients undergoing surgery. 15 Data from several large studies have demonstrated that third-generation HES solutions have greatly improved and do not increase risk of kidney injury, blood loss, transfusion, coagulopathy, or mortality in cardiac surgical patients. [15][16][17] Another study demonstrated that the administration of tranexamic acid in HES 130/0.4 prime solution study group decreased estimated blood loss and chest tube drainage in comparison to patients receiving Ringer prime solution with or without tranexamic acid postoperatively.…”

“…15 Data from several large studies have demonstrated that third-generation HES solutions have greatly improved and do not increase risk of kidney injury, blood loss, transfusion, coagulopathy, or mortality in cardiac surgical patients. [15][16][17] Another study demonstrated that the administration of tranexamic acid in HES 130/0.4 prime solution study group decreased estimated blood loss and chest tube drainage in comparison to patients receiving Ringer prime solution with or without tranexamic acid postoperatively. 5 Even gelatins have a safety profile that is noninferior to crystalloids.…”

“…17 It has been suggested that third-generation HES solutions are safe and effective for plasma volume expansion during cardiac surgery. 15 The other comments from Dr. Reinhart were on the study design and statistical methods used in this study. Our study clearly defined the study goals of comparing 2 different types of 6% HES and their effects on the development of postoperative AKI and the need for blood product transfusion in comparison to patients who did not receive HES.…”