Albumin Use After Cardiac Surgery

Matebele, Mbakise; Ramanan, Mahesh; Thompson, Kelly; Cornmell, George; Shekar, Kiran

doi:10.1097/cce.0000000000000164

Cited by 13 publications

(6 citation statements)

References 48 publications

(39 reference statements)

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“…Matebele al have reported that 4% albumin exposure after cardiac surgery is not significantly associated with hospital mortality but has been associated with significant morbidity (bleeding, tamponade, return to theatre, and increased ICU and hospital LOS) and higher adjusted ICU and hospital costs. 14 A randomized controlled trial is required to determine whether albumin use is effective and safe in this setting.…”

Section: Discussionmentioning

confidence: 99%

Severe hypoalbuminemia complicating a successful atrial switch operation (Senning) with cardiopulmonary bypass - report on a rare case

Datt,

Agarwal

et al. 2024

Int Surg J

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Post-operative hypoalbuminemia has been reported in 12% of neonates and 20% of infants; 97% occurs in the first 48 hours in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass (CPB). Perioperative hypoalbuminemia is not independently associated with any post-operative morbidity. However, when analysed as a continuous variable, lower serum albumin levels have been reported to be associated with increased post-operative morbidity. Pre-operative low serum albumin level is independently associated with increased odds of post-operative hypoalbuminemia, and prolonged length of hospital stay. Immediate post-CPB (0-24 hour), lower serum albumin level is independently associated with an increased duration of mechanical ventilation. There is a relative paucity of literature on the impact of hypoalbuminemia in the paediatric population. Hypoalbuminemia is a marker of poor outcome in critically ill children and those undergoing a wide range of medical interventions. Albumin infusions may be an effective therapy for fluid resuscitation and for patients with severe hypoalbuminemia. We present a successful perioperative management of a 3 months old-male child, weighing 3.5 kg with dextro-transposition of great arteries (D-TGA) with regressed LV undergoing an atrial switch (Senning) procedure, and uneventful intraoperative course i.e. easy weaning from CPB. However, in the ICU, the baby suffered an unusual complication as severe hypoproteinaemia resulting in acute kidney injury (AKI) with complete anuria, generalized anasarca, hypotension requiring inotropes and vasopressors, and difficult weaning from ventilator.

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Section: Discussionmentioning

confidence: 99%

Severe hypoalbuminemia complicating a successful atrial switch operation (Senning) with cardiopulmonary bypass - report on a rare case

Datt,

Agarwal

et al. 2024

Int Surg J

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“…Postoperative bleeding following cardiothoracic procedures remains an important concern with multiple avenues of investigation continuing to assess factors predisposing and potentially influencing the severity of this adverse event. Recent areas of interest include: development of new antifibrinolytic agents to reduce bleeding; 31 measurement of platelet function to reduce bleeding and mortality; 32 single or dual agent antiplatelet therapy to maximize bypass graft patency, but increase postoperative bleeding; 33 – 36 direct linkage of postoperative cardiac surgical bleeding with increased cost; 4 , 5 safe and efficacious use of postoperative fibrinogen concentrates; 37 , 38 role of patient blood management in reducing blood product transfusion and improving cardiac surgical outcomes; 39 , 40 transfusion reductions associated with the use of prothrombin complex concentrate; 41 , 42 morbidity associated with reoperation for bleeding following cardiac surgery; 3 , 43 , 44 methods of employing thromboelastometry (ROTEM) during cardiac surgery; 45 , 46 contribution of albumin/gelatin to postoperative bleeding; 47 – 49 advantages of anticoagulation management using thromboelastography (TEG) during cardiopulmonary bypass; 50 – 52 benefit of thrombin inhibitors for pediatric VAD anticoagulation; 53 , 54 reduction of postoperative blood loss using Unilastin as an antifibrinolytic agent; 55 , 56 and blood loss leading to multisystem organ failure and hematologic complications following LVAD insertion. 7 , 57 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Safety and Efficacy of a Novel Thrombin Containing Combination Hemostatic Powder Using a Historical Control

Bruckner

Spotnitz

Suarez

et al. 2021

Clin Appl Thromb Hemost

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This clinical study compares 2 hemostatic agents, a novel combination powder (CP) (HEMOBLAST™ Bellows) and an established polysaccharide starch powder (PP) (Arista™ AH) to assess the usefulness of CP. Retrospective comparative analysis of CP (July 2018 to July 2019, 68 patients) to PP (January 2011 to January 2013, 94 patients) in cardiothoracic patients was performed using linear regression models adjusting for age, sex, and procedure type for the endpoints: blood loss; protamine to skin closure time (hemostasis time); chest tube output and blood products required 48 hours postoperatively; ICU stay; postoperative comorbidities; and 30 day mortality. 162 patients (108 M: 54 F) underwent 162 cardiothoracic surgical procedures including: transplantation (n = 44), placement of ventricular assist device (n = 87), and others (n = 31). Use of CP compared to PP (Estimated Mean Difference [95% CI], P-value) produced significant reductions: blood loss (mL) (−886.51 [−1457.76, −312.26], P = 0.003); protamine to skin closure time (min) (−16.81 [−28.03, −5.59], P = 0.004); chest tube output (48 hrs, mL) (−445.76 [−669.38, −222.14], P < 0.001); packed red blood cell transfusions (units) (−0.98 [−1.56, −0.4], P = 0.001); and postoperative comorbidities (−0.31 [−0.55, −0.07], P = 0.012). There were no differences in the ICU stay (4.07 [−2.01, 10.15], P = 0.188) or 30-day mortality (0.57 [0.20, 1.63], P = 0.291). The use of CP in complex cardiothoracic operations resulted in improved hemostasis and significant clinical benefits in blood loss, transfusion requirements, morbidity, and time in operating room.

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“…There was no difference in adjusted mortality between those who did or did not receive albumin (adjusted OR, 1.24; 95% CI, 0.56 to 2.79; P = 0.6). 74 More recent prospective studies in cardiac surgical patients have reported improved clinical outcomes, although sample sizes have generally been small, and a risk of publication bias prevails. The 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients After Cardiac Surgery (HAS-FLAIR) study was a singlecentre, open-label pilot which included 100 consecutive cardiac surgical patients requiring volume resuscitation or improvement in cardiac index in the first 24 postoperative hours.…”

Section: Methodsmentioning

confidence: 99%

Albumin in adult cardiac surgery: a narrative review

Hanley

Callum

Karkouti

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Intravascular fluids are a necessary and universal component of cardiac surgical patient care. Both crystalloids and colloids are used to maintain or restore circulating plasma volume and ensure adequate organ perfusion. In Canada, human albumin solution (5% or 25% concentration) is a colloid commonly used for this purpose. In this narrative review, we discuss albumin supply in Canada, explore the perceived advantages of albumin, and describe the clinical literature supporting and refuting albumin use over other fluids in the adult cardiac surgical population. Source We conducted a targeted search of PubMed, Embase, Medline, Web of Science, ProQuest Dissertations and Theses Global, the Cochrane Central Register of Controlled trials, and the Cochrane Database of Systematic Reviews. Search terms included albumin, colloid, cardiac surgery, bleeding, hemorrhage, transfusion, and cardiopulmonary bypass. Principal findings Albumin is produced from fractionated human plasma and imported into Canada from international suppliers at a cost of approximately $21 million CAD per annum. While it is widely used in cardiac surgical patients across the country, it is approximately 30-times more expensive than equivalent doses of balanced crystalloid solutions, with wide inter-institutional variability in use and no clear association with improved outcomes. There is a general lack of high-quality evidence for the superiority of albumin over crystalloids in this patient population, and conflicting evidence regarding safety. Conclusions In cardiac surgical patients, albumin is widely utilized despite a lack of high-quality evidence supporting its efficacy or safety. A well-designed randomized controlled trial is needed to clarify the role of albumin in cardiac surgical patients. Re ´sumeÓbjectif Les liquides intravasculaires sont une composante ne´cessaire et universelle des soins aux patients de chirurgie cardiaque. Les cristalloı¨des et les colloı¨des sont utilise´s pour maintenir ou restaurer le volume plasmatique en circulation et assurer une perfusion ade´quate des organes. Au Canada, les solutions d'albumine humaine (concentration de 5 % ou 25 %) constituent un colloı¨de couramment utilise´a`cette fin. Dans

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Albumin Use After Cardiac Surgery

Abstract: Supplemental Digital Content is available in the text.

Cited by 13 publications

References 48 publications

Severe hypoalbuminemia complicating a successful atrial switch operation (Senning) with cardiopulmonary bypass - report on a rare case

Severe hypoalbuminemia complicating a successful atrial switch operation (Senning) with cardiopulmonary bypass - report on a rare case

Evaluation of the Safety and Efficacy of a Novel Thrombin Containing Combination Hemostatic Powder Using a Historical Control

Albumin in adult cardiac surgery: a narrative review

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