Key result
Albumin bypass prime preserves renal function with a ~7-point smaller GFR drop versus starch.
Why the study?
The ideal priming solution for cardiopulmonary bypass in adult cardiac surgery and its effects on renal function and coagulation remain debated.
Does 5% Albumin compared to 6% Hydroxyethyl Starch as a cardiopulmonary bypass priming solution improve renal function and reduce bleeding in patients undergoing elective CABG?
RCT (n=60)
Double-blind
Computerized randomization table
No
Does 5% Albumin compared to 6% Hydroxyethyl Starch as a cardiopulmonary bypass priming solution improve renal function and reduce bleeding in patients undergoing elective CABG?
Using 5% Albumin instead of 6% HES for cardiopulmonary bypass priming in elective CABG patients preserves renal function and reduces postoperative bleeding.
Answers are grounded in this paper and cite their sources.
Favors 5% albumin over 6% HES for CPB priming in elective CABG to limit GFR decline and bleeding; extends RCT evidence on colloid selection.
Background: The ideal strategy to prime the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery is still a matter of debate. Objectives: In this retrospective study, we examined Albumin solution and hydroxyethyl starch (HES) for priming the CPB circuit and evaluated the differences in kidney function and bleeding and coagulation status in the two groups of patients. Patients and Methods: Sixty consecutive patients undergoing elective coronary artery bypass grafting were studied. Patients were excluded due to emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. The patients were divided randomly into two groups of HES (n = 30) and Albumin (n = 30). Hemodynamic parameters, serum creatinine concentrations and glomerular filtration rate, PT, PTT and INR were measured. Early bleeding was measured according to the first 24-hour drainage from the tube. Hemodynamics and all laboratory measurements were performed after induction of anesthesia and at the morning of the first, second and third postoperative days in the ICU. Results: GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation. Platelet count difference and postoperative bleeding were significantly lower in Albumin group. Conclusions: Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine.
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Maleki et al. (2015) conducted an RCT in Elective Coronary Artery Bypass Grafting (CABG) (n=60). 5% Human Albumin vs. 500 mL of 6% Hydroxyethyl Starch (HES) 130/0.4 in 0.9% sodium chloride was evaluated on Change in Glomerular Filtration Rate (GFR) from baseline at 24 hours postoperation (p=<0.0001). Administration of 5% human albumin as a cardiopulmonary bypass priming solution resulted in a significantly smaller drop in GFR at 24 hours compared to 6% hydroxyethyl starch (-4.82 vs -12.14, p<0.0001), as well as significantly less early postoperative bleeding.
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