What question did this study set out to answer?

To determine whether colloid choice in cardiopulmonary bypass priming fluid independently modifies perioperative acid–base trajectories in patients undergoing elective coronary artery bypass surgery.

August 1, 2026Journal of Cardiothoracic and Vascular AnesthesiaOpen Access

Impact of Colloid Cardiopulmonary Bypass Priming Strategy on Perioperative Acid–Base Balance in Coronary Artery Bypass Surgery: Physiochemical Analysis of a Double–Blinded Randomised Controlled Study

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Authors

RBRohan BoerAmsterdam University Medical Centers ABAnne M. BeukersUniversity of Amsterdam JPJiska M. PolsAmsterdam University Medical Centers

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Implication

Randomized double-blind trial reveals bypass priming colloid choice does not alter acid–base balance in cardiac surgery, indicating crystalloid volume primarily drives perioperative acidosis.

Key Points

To determine whether colloid choice in cardiopulmonary bypass priming fluid independently modifies perioperative acid–base trajectories in patients undergoing elective coronary artery bypass surgery.
Single-centre, double-blind, three-arm randomized controlled trial of 34 adult patients undergoing elective coronary artery bypass surgery with cardiopulmonary bypass.
Patients were randomized 1:1:1 to 1500-mL priming strategies: albumin-based, gelofusine-based, or retrograde autologous priming as the reference group.
Acid–base status was assessed using Stewart's physicochemical approach across five perioperative time points (induction to 24 hours post-ICU admission) and analyzed with linear mixed models.
Cardiopulmonary bypass initiation induced substantial metabolic acidosis (−0.1 pH, −4.3 mmol/L standard base excess, and −6.6 mEq/L effective strong ion difference) persisting at 24 hours, with no significant differences in pH, standard base excess, or effective strong ion difference between priming strategies.
Albumin attenuated weak-acid-anion dilution (+0.79 mEq/L; p=0.037), whereas gelofusine significantly expanded the strong ion gap (+2.19 mEq/L; p<0.001).
Each additional liter of crystalloid independently reduced pH (−0.011; p=0.035), standard base excess (−0.99 mmol/L; p=0.022), and effective strong ion difference (−1.03 mEq/L; p=0.025), driven by an increase in the strong ion gap (+1.24 mEq/L; p=0.001).

Cite This Study

Boer et al. (2026) studied this question.

synapsesocial.com/papers/6a9fba8400f21bf9f8ec6f0e https://doi.org/10.1053/j.jvca.2026.08.164

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Implication

Randomized double-blind trial reveals bypass priming colloid choice does not alter acid–base balance in cardiac surgery, indicating crystalloid volume primarily drives perioperative acidosis.

Impact of Colloid Cardiopulmonary Bypass Priming Strategy on Perioperative Acid–Base Balance in Coronary Artery Bypass Surgery: Physiochemical Analysis of a Double–Blinded Randomised Controlled Study

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Cite This Study

Impact of Colloid Cardiopulmonary Bypass Priming Strategy on Perioperative Acid–Base Balance in Coronary Artery Bypass Surgery: Physiochemical Analysis of a Double–Blinded Randomised Controlled Study

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