Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer’s lactate on blood loss and coagulation after cardiac surgery

Skhirtladze, Keso; Base, Eva; Lassnigg, Andrea; Kaider, Alexandra; Linke, S.; Dworschak, Martin; Hiesmayr, Michael

doi:10.1093/bja/aet348

Cited by 127 publications

(99 citation statements)

References 42 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A large observational study with over 6000 patients found increased need for RRT among patients undergoing cardiac surgery who received either HES or gelatin compared to crystalloids [29]. HES increased the need for RRT and blood products during cardiac surgery [30]. Triggered by safety concerns from large-scale RCTs, the European Medicines Agency (EMA) re-assessed the safety and efficacy of HES solutions and decided to restrict its use in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

et al. 2014

View full text Add to dashboard Cite

BackgroundManagement of cardiac surgery patients is a very standardized procedure in respective local institutions. Yet only very limited evidence exists concerning optimal indication, safety and efficacy of hemodynamic monitoring catecholamine and fluid therapy.MethodsBetween April and May 2013, all 81 German anaesthesia departments involved in cardiac surgery care were asked to participate in a questionnaire addressing the institutional specific current practice in hemodynamic monitoring, catecholamine and volume therapy.Results51 (63%) questionnaires were completed and returned. All participating centers used basic hemodynamic monitoring (i.e. invasive arterial blood pressure and central venous pressure), supplemented by transesophageal echocardiography. Pulmonary arterial catheter and calibrated trend monitoring devices were also routinely available. In contrast, non-calibrated trend monitoring and esophageal doppler ultrasound devices were not commonly in use. Cerebral oximetry is increasingly emerging, but lacks clear indications. The majority of patients undergoing cardiac surgery, especially in university hospitals, required catecholamines during perioperative care, In case of low cardiac output syndrome, dobutamine (32%), epinephrine (30%) or phosphodiesterase inhibitors (8%) were first choice. In case of hypotension following vasoplegia, norepinephrine (96%) represented the most common catecholamine. 88% of the participating centers reported regular use of colloid fluids, with hydroxyethyl starches (HES) being first choice (64%).ConclusionsChoice of hemodynamic monitoring is homogenous throughout German centers treating cardiac surgery patients. Norepinephrine is the first line catecholamine in cases of decrease in peripheral vascular resistance. However, catecholamine choice for low cardiac output syndrome varies considerably. HES was the primary colloid used for fluid resuscitation. After conduct of this survey, HES use was restricted by European regulatory authorities in critically ill patients and should only be considered as second-line fluid in surgical patients without renal impairment or severe coagulopathy. Large clinical studies addressing catecholamine and fluid therapy in cardiac surgery patients are lacking.

show abstract

Section: Discussionmentioning

confidence: 99%

Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The colloids impaired clot formation and clot strength more than Ringer's lactate and the amount of transfused blood products was larger in the patient groups receiving colloids than Ringer's lactate [17].…”

Section: Discussionmentioning

confidence: 81%

Haemostasis monitored in stored red blood cells, plasma and platelet concentrates in the proportion of 4

Ågren

Edgren

Ambrosio

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

View full text Add to dashboard Cite

The aim of this in-vitro study was to evaluate haemostasis analysed with thromboelastometry and blood gas and blood count variables, in stored blood components and the effects after dilution with Ringer[Combining Acute Accent]s acetate, albumin and hydroxyethyl starch (HES). Aliquots from stored red blood cells, plasma and platelet concentrates were mixed in the proportion of 4 : 4 : 1 and analysed with rotational thromboelastometry (ROTEM), blood count [haemoglobin (Hb), haematocrit, platelet count] and blood gas (pH, calcium, sodium, potassium, glucose levels). The blood mix was thereafter diluted 20 and 33% with Ringer's acetate, albumin or HES. The stored blood component mix in a ratio of 4 : 4 : 1 had a low pH (7.11 ± 0.03, mean ± standard deviation), nonmeasurable calcium level, and high concentrations of sodium, potassium and glucose but ROTEM curves within normal range after recalcification. With Ringer's acetate dilution, the ROTEM variables changed almost linearly with increasing dilution volume. When albumin was used in the 33% dilution, the clot firmness of the fibrin clot (FibTEM) was further reduced, and with HES dilution, there was a pronounced impairment. The stored blood mix had a low pH and calcium level, both of which might have a significant influence on the coagulation process but normal ROTEM curves after recalcification. Dilution with Ringer's acetate and albumin resulted in moderate deterioration, while dilution with HES showed severely impaired haemostasis.

show abstract

“…The mean estimated blood loss was 773 ± 287 mL. We assumed that half of the standard deviation (143 mL) would be considered a clinically significant difference in blood loss between the HES group and the crystalloid group as previously described elsewhere [15]. Furthermore, 143 mL is approximately 20 % blood reduction, which is a clinically meaningful.…”

Section: Methodsmentioning

confidence: 99%

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

et al. 2016

View full text Add to dashboard Cite

Background Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use. Methods We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group). Results Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intra-operative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group. Conclusions Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.

show abstract

Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer’s lactate on blood loss and coagulation after cardiac surgery

Abstract: Despite equal blood loss from chest drains, both colloids interfered with blood coagulation and produced greater haemodilution, which was associated with more transfusion of blood products compared with crystalloid use only.

Cited by 127 publications

References 42 publications

Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

Haemostasis monitored in stored red blood cells, plasma and platelet concentrates in the proportion of 4

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

Contact Info

Product

Resources

About