Human albumin is the conventional cardiopulmonary bypass circuit primer. However, it has high manufacturing costs. Crystalloid and colloid solutions have been developed as alternatives, including a new generation of non-ionic hydroxyethyl starch (HES). The efficacy of hydroxyethyl starch with a 130 molecular weight and substitution degree of 0.4 (hydroxyethyl starch 130/0.4) was compared with human albumin for use in cardiopulmonary bypass surgery in American Society of Anesthesiologists’ grade I-II pediatric congenital heart disease patients. Efficacy was evaluated by comparing perioperative hemodynamic parameters, including plasma colloid osmotic pressure, renal function, blood loss, allogeneic blood volumes and plasma volume substitution. The hydroxyethyl starch group exhibited significantly higher preoperative colloid osmotic pressure (p<0.01) and significantly lower operative renal function and postoperative allogeneic blood volumes than the human albumin group. No significant differences were observed in serum creatinine, glucose, hematocrit or lactic acid levels (p>0.05). Our results indicate that hydroxyethyl starch may be a viable alternative to human albumin in pediatric patients undergoing relatively simple cardiopulmonary bypass surgeries.
ShahbaziSZeighamiAAllahyaryE. Effect of colloid versus crystalloid administration of cardiopulmonary bypass prime solution on tissue and organ perfusion. Iranian Cardiovascular Research Journal2011; 5: 24–31.
2.
StrundenMSHeckelKGoetzAE. Perioperative fluid and volume management: physiological basis, tools and strategies. Ann Intensive Care2011; 1: 2.
3.
McIlroyDRKharaschED. Acute intravascular volume expansion with rapidly administered crystalloid or colloid in the setting of moderate hypovolemia. Anesth Analg2003; 96: 1572–1577.
4.
TollofsrudSSvennevigJLBreivikH. Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer’s acetate compared with dextran, polygeline, or albumin. Acta Anaesthesiol Scand1995; 39: 671–677.
5.
LiuJJiBLongC. Which is the optimal option during pediatric cardiopulmonary bypass: high colloid oncotic pressure priming, ultrafiltration or both?Eur J Cardiothorac Surg2011; 40: 772.
6.
GolabHDScohyTVde JongPL. Relevance of colloid oncotic pressure regulation during neonatal and infant cardiopulmonary bypass: a prospective randomized study. Eur J Cardiothorac Surg2011; 39: 886–891.
7.
CecereGGroomRForestR. A 10-year review of pediatric perfusion practice in North America. Perfusion2002; 17: 83–89.
8.
RussellJANavickisRJWilkesMM. Albumin versus crystalloid for pump priming in cardiac surgery: meta-analysis of controlled trials. J Cardiothorac Vasc Anesth2004; 18: 429–437.
9.
StandlTLochbuehlerHGalliC. HES 130/0.4 (Voluven) or human albumin in children younger than 2 yr undergoing non-cardiac surgery. A prospective, randomized, open label, multicentre trial. Eur J Anaesthesiol2008; 25: 437–445.
10.
OoiJSRamzishamARZamrinMD. Is 6% hydroxyethyl starch 130/0.4 safe in coronary artery bypass graft surgery?Asian Cardiovasc Thorac Ann2009; 17: 368–372.
11.
McKeePACastelliWPMcNamaraPM. The natural history of congestive heart failure: the Framingham study. N Engl J Med1971; 285: 1441–1446.
AukermanJVoepel-LewisTRieggerLQ. The relationship between extracorporeal circuit prime, albumin, and postoperative weight gain in children. J Cardiothorac Vasc Anesth1998; 12: 408–414.
14.
AkkucukFGKanbakMAyhanB. The effect of HES (130/0.4) usage as the priming solution on renal function in children undergoing cardiac surgery. Ren Fail2013; 35: 210–215.
15.
ErtmerCRehbergSVan AkenH. Relevance of non-albumin colloids in intensive care medicine. Best Pract Res Clin Anaesthesiol2009; 23: 193–212.
16.
HartogCSBauerMReinhartK. The efficacy and safety of colloid resuscitation in the critically ill. Anesth Analg2011; 112: 156–164.
17.
HanartCKhalifeMDe VilleA. Perioperative volume replacement in children undergoing cardiac surgery: albumin versus hydroxyethyl starch 130/0.4. Crit Care Med2009; 37: 696–701.
18.
EisingGPNiemeyerMGuntherT. Does a hyperoncotic cardiopulmonary bypass prime affect extravascular lung water and cardiopulmonary function in patients undergoing coronary artery bypass surgery?Eur J Cardiothorac Surg2001; 20: 282–289.
19.
MehlhornUAllenSJDavisKL. Increasing the colloid osmotic pressure of cardiopulmonary bypass prime and normothermic blood cardioplegia minimizes myocardial oedema and prevents cardiac dysfunction. Cardiovasc Surg1998; 6: 274–281.
20.
TamayoEAlvarezFJAlonsoO. The inflammatory response to colloids and crystalloids used for pump priming during cardiopulmonary bypass. Acta Anaesthesiol Scand2008; 52: 1204–1212.
21.
CooperJRGieseckeNM. Hemodilution and priming solutions. In: GravleeGPDavisRFKuruszMUttleJR (eds). Cardiopulmonary Bypass: Principles and Practice. 2nd ed.2003, Lippincott Williams & Wilkins, Philadelphia, PA, Ch 11.
22.
BrunkhorstFMEngelCBloosF. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med2008; 358: 125–139.
23.
PernerAHaaseNGuttormsenAB. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med2012; 367: 124–134.
24.
MyburghJAFinferSBellomoR. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med2012; 367: 1901–1911.
25.
HunsickerOFrancisRC. Assessment of hemodynamic efficacy and safety of 6% hydroxyethyl starch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: how to guide fluid therapy?Crit Care2012; 16: 464.
26.
MullerLJaberSMolinariN. Fluid management and risk factors for renal dysfunction in patients with severe sepsis and/or septic shock. Crit Care2012; 16: R34.
27.
AnnaneDSiamiSJaberS. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA2013; 310: 1809-1817.
28.
Van der LindenPDe VilleAHoferA. Six percent hydroxyethyl starch 130/0.4 (Voluven®) versus 5% human serum albumin for volume replacement therapy during elective open-heart surgery in pediatric patients. Anesthesiology2013; 119: 1296-1309.
29.
MartinCJacobMVicautE. Effect of waxy maize-derived hydroxyethyl starch 130/0.4 on renal function in surgical patients. Anesthesiology2013; 118: 387–394.
