Dextran- Versus Crystalloid-Based Prime in Cardiac Surgery: A Prospective Randomized Pilot Study

Barbu, Mikael; Kolsrud, Oscar; Ricksten, Sven‐Erik; Dellgren, Göran; Zetterberg, Henrik; Blennow, Kaj; Björk, Kerstin; Thorén, Anders; Hansson, Christoffer; Jeppsson, Anders

doi:10.1016/j.athoracsur.2020.03.031

Cited by 12 publications

(16 citation statements)

References 22 publications

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“…The study's main results have been published elsewhere. 14 For the present secondary analysis, blood samples for analysis of five brain injury markers (GFAP, S100B, NSE, tau, and NfL) and the blood-brain barrier injury marker β-trace protein were collected from the arterial line at three time points: before surgery (after induction of anesthesia); 2 h after CPB, and 24 h after CPB. At the same time points, the degree of hemolysis was measured as it is known that hemolysis interacts with the analysis of NSE.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the clinical management have been published before. 14 In short, anesthesia was induced with fentanyl and propofol followed by rocuronium, and maintained with sevoflurane. The CPB circuit was primed with 1,300 mL solution according to the blood-brain barrier injury.…”

Section: Clinical Managementmentioning

confidence: 99%

“…To this purpose, we performed a predefined secondary analysis from data collected in a prospective randomized trial. 14 A secondary aim was to study potential associations between biomarker levels and patients' age, operation time, and degree of perioperative hemolysis.…”

Section: Introductionmentioning

confidence: 99%

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Serum biomarkers of brain injury after uncomplicated cardiac surgery: Secondary analysis from a randomized trial

Barbu

Jónsson

Zetterberg

et al. 2022

Acta Anaesthesiol Scand

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Background: Postoperative cognitive dysfunction is common after cardiac surgery.Postoperative measurements of brain injury biomarkers may identify brain damage and predict cognitive dysfunction. We describe the release patterns of five brain injury markers in serum and plasma after uncomplicated cardiac surgery.Methods: Sixty-one elective cardiac surgery patients were randomized to undergo surgery with either a dextran-based prime or a crystalloid prime. Blood samples were taken immediately before surgery, and 2 and 24 h after surgery. Concentrations of the brain injury biomarkers S100B, glial fibrillary acidic protein (GFAP), tau, neurofilament light (NfL) and neuron-specific enolase (NSE)) and the blood-brain barrier injury marker β-trace protein were analyzed. Concentrations of brain injury biomarkers were correlated to patients' age, operation time, and degree of hemolysis.Results: No significant difference in brain injury biomarkers was observed between the prime groups. All brain injury biomarkers increased significantly after surgery (tau +456% (25th-75th percentile 327%−702%), NfL +57% (28%−87%), S100B +1145% (783%−2158%), GFAP +17% (−3%−43%), NSE +168% (106%−228%), while β-trace protein was reduced (−11% (−17−3%). Tau, S100B, and NSE peaked at 2h, NfL and GFAP at 24 h. Postoperative concentrations of brain injury markers correlated to age, operation time, and/or hemolysis. Conclusion:Uncomplicated cardiac surgery with cardiopulmonary bypass is associated with an increase in serum/plasma levels of all the studied injury markers, without signs of This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Methodsmentioning

confidence: 99%

Section: Clinical Managementmentioning

confidence: 99%

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Serum biomarkers of brain injury after uncomplicated cardiac surgery: Secondary analysis from a randomized trial

Barbu

Jónsson

Zetterberg

et al. 2022

Acta Anaesthesiol Scand

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“…The promising properties of the isolated protein cocktail in hemolysis treatment were tested in vivo by administering mechanically hemolyzed blood plasma mixed with either the protein cocktail or dextran 70 kDa (Dex70) via exchange transfusion at 5% of the animal's total Hb mass. Dex70 was chosen for comparison given its improved plasma expansion properties compared to HSA, potential anti‐inflammatory effects, and interest as a pump‐priming fluid 30,31 . Ferritin levels in the heart, kidney, liver, and blood were measured, and markers of tissue inflammation or injury were also assessed.…”

Section: Resultsmentioning

confidence: 99%

Purification and analysis of a protein cocktail capable of scavenging cell‐free hemoglobin, heme, and iron

et al. 2021

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Background Hemolysis releases toxic cell‐free hemoglobin (Hb), heme, and iron, which overwhelm their natural scavenging mechanisms during acute or chronic hemolytic conditions. This study describes a novel strategy to purify a protein cocktail containing a comprehensive set of scavenger proteins for potential treatment of hemolysis byproducts. Study Design and Methods Tangential flow filtration was used to purify a protein cocktail from Human Cohn Fraction IV (FIV). A series of in vitro assays were performed to characterize composition and biocompatibility. The in vivo potential for hemolysis byproduct mitigation was assessed in a hamster exchange transfusion model using mechanically hemolyzed blood plasma mixed with the protein cocktail or a control colloid (dextran 70 kDa). Results A basis of 500 g of FIV yielded 62 ± 9 g of a protein mixture at 170 g/L, which bound to approximately 0.6 mM Hb, 1.2 mM heme, and 1.2 mM iron. This protein cocktail was shown to be biocompatible in vitro with red blood cells and platelets and exhibits nonlinear concentration dependence with respect to viscosity and colloidal osmotic pressure. In vivo assessment of the protein cocktail demonstrated higher iron transport to the liver and spleen and less to the kidney and heart with significantly reduced renal and cardiac inflammation markers and lower kidney and hepatic damage compared to a control colloid. Discussion Taken together, this study provides an effective method for large‐scale production of a protein cocktail suitable for comprehensive reduction of hemolysis‐induced toxicity.

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“…According to the original study, the primary end‐point was the plasma oncotic pressure during CPB. A power calculation estimated that it would take 40 patients in each group to detect a 30% difference in oncotic pressure between the groups with 90% power and a significance level of 0.05 24 . A post hoc analysis revealed that the power to detect a 50% difference in peak urinary NAG/creatinine ratio was 0.65 at an SD of 4.5.…”

Section: Methodsmentioning

confidence: 99%

Dextran‐based priming solution during cardiopulmonary bypass attenuates renal tubular injury—A secondary analysis of randomized controlled trial in adult cardiac surgery patients

Kolsrud

Barbu

Dellgren

et al. 2021

Acta Anaesthesiol Scand

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Background Acute kidney injury (AKI) is a well‐known complication after cardiac surgery and cardiopulmonary bypass (CPB). In the present secondary analysis of a blinded randomized controlled trial, we evaluated the effects of a colloid‐based versus a conventional crystalloid‐based prime on tubular injury and postoperative renal function in patients undergoing cardiac surgery with CPB. Methods Eighty‐four adult patients undergoing cardiac surgery with CPB were randomized to receive either a crystalloid‐ or colloid‐ (dextran 40) based CPB priming solution. The crystalloid solution was based on Ringer‐Acetate plus mannitol. The tubular injury biomarker, N‐acetyl‐b‐D‐glucosaminidase (NAG), serum creatinine and diuresis were measured before, during and after CPB. The incidence of AKI was assessed according to the KDIGO criteria. Results The urinary‐NAG/urinary‐creatinine ratio rose in both groups during and after CPB, with a more pronounced increase in the crystalloid group (p = .038). One hour after CPB, the urinary‐NAG/urinary‐creatinine ratio was 88% higher in the crystalloid group (4.7 ± 6.3 vs. 2.5 ± 2.7, p = .045). Patients that received the dextran 40‐based priming solution had a significantly lower intraoperative diuresis (p < .001) compared to the crystalloid group. The incidence of AKI was 18% in the colloid and 22% in the crystalloid group (p = .66). Postoperative serum creatinine did not differ between groups. Conclusions In patients undergoing cardiac surgery with CPB, colloid‐based priming solution (dextran 40) induced less renal tubular injury compared to a crystalloid‐based priming solution. Whether a colloid‐based priming solution will improve renal outcome in high‐risk cardiac surgery, or not, needs to be evaluated in future studies on higher risk cardiac surgery patients.

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Dextran- Versus Crystalloid-Based Prime in Cardiac Surgery: A Prospective Randomized Pilot Study

Cited by 12 publications

References 22 publications

Serum biomarkers of brain injury after uncomplicated cardiac surgery: Secondary analysis from a randomized trial

Serum biomarkers of brain injury after uncomplicated cardiac surgery: Secondary analysis from a randomized trial

Purification and analysis of a protein cocktail capable of scavenging cell‐free hemoglobin, heme, and iron

Dextran‐based priming solution during cardiopulmonary bypass attenuates renal tubular injury—A secondary analysis of randomized controlled trial in adult cardiac surgery patients

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