Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

Gelatin and the risk of bleeding after cardiac surgery

“…Previous meta-analysis comparing gelatin to crystalloid as a priming solution was unable to find any difference in bleeding postoperatively in 24 hours. 32 The difference between that meta-analysis and the current study may be due to a much larger number of patients in the current study and the fact that we studied effects of postoperatively infused gelatin/crystalloid compared to priming solutions in Ghijselings study. 32 In earlier studies, colloids induced a greater need for RBC transfusions.…”

“…32 The difference between that meta-analysis and the current study may be due to a much larger number of patients in the current study and the fact that we studied effects of postoperatively infused gelatin/crystalloid compared to priming solutions in Ghijselings study. 32 In earlier studies, colloids induced a greater need for RBC transfusions. 15 One reason for this may be that gelatin expands intravascular volume more effectively and therefore causes hemodilution, which prompts the transfusion of RBCs.…”

“…Gelatin and HES have not been shown to increase the volume of bleeding compared to crystalloids in earlier studies; however, those studies had smaller patient populations. 4,7,32 This study has some limitations, including its retrospective nature. Postoperative bleeding after cardiac surgery has many etiological factors in addition to gelatin infusion.…”

Effects of different plasma expanders on rats subjected to severe acute normovolemic hemodilution

“…In recent years, the safety of using the above mentioned colloids intraoperatively has been extensively debated [ 12 ]. Large randomized controlled trials [ 13 ] have reported that the use of HES130 is associated with an increased risk of renal dysfunction in patients requiring renal replacement therapy and a higher mortality rate in patients with severe sepsis who receive 6% HES130 [ 14 ].…”

α7 nicotinic acetylcholine receptor agonist inhibits the damage of rat hippocampal neurons by TLR4/Myd88/NF-κB signaling pathway during cardiopulmonary bypass

“…Τoll like receptor 4 (TLR4)/myeloid differentiation primary response 88 (Myd88)/nuclear factor (NF)-κB pathway plays a vital role in inflammatory signaling, activation and regulation. Studies have shown that activation of α7nAchR can inhibit the binding between microglia and lipopolysaccharide, significantly reduce TNF-α release, and exert anti-inflammatory effect in neonatal brain injury ( 8 , 9 ). Activation of α7nAchR can antagonize the toxicity of β-amyloid and serves as a treatment approach of Alzheimer's disease.…”