A comparison of albumin, polygeline and crystalloid priming solutions for cardiopulmonary bypass in patients having coronary artery bypass graft surgery

Abstract

This study was designed to assess the effect of different prime solution compositions on a patient's fluid balance, transfusion requirements, renal function and haemodynamic stability over the first 24 hours postbypass. Ninety-three patients presenting for first-time coronary artery bypass graft (CABG) surgery were randomly allocated to receive one of three prime solutions for the CPB pump: albumin (4.6%) + Plasmalyte (Group A, n = 32), polygeline (Hemaccel) + Plasmalyte (Group P, n = 29), or crystalloid (Plasmalyte) alone (Group C, n = 32). Patients, anaesthetists, surgeons and intensive care unit (ICU) staff were all blinded as to the solution type. The groups were demographically and haemodynamically similar. There were no differences between the groups with respect to white cell or platelet counts during the study. There was a significant difference in haemoglobin levels between the groups on weaning from CPB and on arrival in the ICU (Group C > Groups P and A, p < 0.001 for both times). There was no difference in blood transfusion requirements between any of the groups. During CPB, Group C required significantly more crystalloid than the other groups (p < 0.001). Urine output was significantly higher in Group C compared with Groups P and A at all time periods up to and including ICU 12 hours (p < 0.05). The use of frusemide was significantly higher in the ICU in Groups P and A (p < 0.01). There was a net gain of 3132 +/- 412 ml in Group C in 24 hour fluid balance, which was significantly higher than Group A (2166 +/- 223 ml, p = 0.04). Our results show that, in this patient population, there is no advantage in using a colloid-based prime solution over a purely crystalloid solution from a haemotologic or haemodynamic point of view for the first 24 hours after CPB. There appears to be an increase in extracellular fluid (ECF) retention in Group C, but this caused no related problems in the study period. On the other hand, diuretics (frusemide) needed to be given significantly less often in these patients to offset oliguria.

Intra- and extravascular volume status in patients undergoing mitral valve replacement

“…Thus, patients in the RL group should have suffered from a more pronounced myocardial oedema than patients in the HA group. In patients undergoing surgery for CABG, either no or only insignificant depression of cardiac performance was observed when a pure crystalloid priming was used [7,16,17,25,29]. In the present study, SVI was significantly decreased in the immediate postoperative period in patients receiving pure crystalloid priming (30 Ϯ 6 vs. 40 Ϯ 7 mL m Ϫ2 , P Ͻ 0.01) when compared to baseline.…”

“…During CPB, extravasation of fluid leads to depletion of intravascular volume so that additional crystalloids are required to maintain the volume of the venous reservoir, pump flow and intravascular volume load. This explains why patients in the RL group received significantly more crystalloids intraoperatively (in an amount exceeding the priming volume) and had markedly higher total fluid balances than patients in the HA group [5,16,17].…”

“…Thus, net filtration of fluid into the interstitium is increased during and after extracorporeal circulation, resulting in elevated extravascular lung water content [4,13] and oedema formation in the myocardial interstitium [3,14] which can contribute to ventricular dysfunction. However, it is still questionable if the negative sideeffects of CPB can be influenced by the composition of the priming solution [4,6,7,13,[15][16][17]. Both crystalloid and colloid priming solutions are still in use and no standard has gained general acceptance until now [18][19][20].…”

Fluid and Electrolyte Therapy in Cardiac Surgery

“…Değişik başlangıç solüsyonu kompozisyonları bildiren çalışmalar olup, sonuçları birbirinden oldukça uzaktır. İyi planlanmış birkaç çalışmada başlangıç solüsyonunun etkileri araştırılmıştır (30)(31)(32)(33)(34)(35)(36)(37) . Bu çalışmalar yalnızca kristaloid kolloid karşılaştırması (30,33,34) şeklin-de değil, aynı zamanda hangi kolloid sorusuna da yanıt verecek şekildedir.…”

Choice of a Synthetic Colloid for Surgery

“…Results, however, are far from being conclusive [69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88] . Asanguineous priming of the CPB circuit has been supported since it was found that homologous blood priming was an important cause of post-cardiopulmonary bypass pulmonary dysfunction (pump lung).…”