Albumin Utilization in Cardiac Surgery After Transition to Hydroxyethyl Starch 130/0.4

Abstract

Objective:

Evaluate the impact of replacing hydroxyethyl starch (HES) 670/0.75 with lower molecular weight HES 130/0.4 on albumin utilization in cardiac surgery, as well as any impact on renal function and bleeding.

Design:

A pre- and postimplementation, retrospective analysis.

Setting:

Community, not-for-profit, tertiary medical center.

Participants:

One hundred forty-six patients undergoing nonemergent cardiac bypass graft and cardiac valve surgeries after exclusion for documented anemia, malignancy, coagulation disorder, end-stage renal disease, or personal objection to receiving blood products.

Intervention:

HES 130/0.4 utilization instead of HES 670/0.75 for volume expansion.

Measurements and Main Results:

Patients were less likely to be administered albumin intraoperatively (odds ratio [OR] 0.16, confidence interval [CI] 0.08-0.35, P < .001). When albumin was utilized, intraoperative amounts were similar (mean ± standard deviation [SD]: 36.1 ± 17.1 g vs 43.8 ± 15.5 g, P = .16). Patients were more likely to receive an intraoperative HES product after the formulary change (OR 11.1, CI 4.4-27.6, P < .001) as well as larger volumes (mean ± SD: 743 ± 544 mL vs 500 ± 0 mL, P = .01). No differences were detected in mean baseline-to-discharge changes in serum creatinine or in postoperative urine output, nor were there differences in clinically significant bleeding.

Conclusions:

Change to a lower molecular weight HES decreased intraoperative albumin utilization and increased HES utilization with no detected difference in renal function or bleeding complications.

Keywords

hydroxyethyl starch hetastarch albumin plasma substitute

Get full access to this article

View all access options for this article.

References

James

. The role of tetrastarches for volume replacement in the perioperative setting. Curr Opin Anaesthesiol. 2008;21(5):674–678.

Huang

Liu

Production of human serum albumin by sugar starvation induced promoter and rice cell culture. Transgenic Res. 2005;14(5):569–581.

Bosse

Praus

Kiessling

Phase I comparability of recombinant human albumin and human serum albumin. J Clin Pharmacol. 2005;45(1):57–67.

Hespan^® (6% hetastarch in 0.9% sodium chloride injection) [package insert]. Irvine, CA: B. Braun Medical, Inc; 2003. Available at http://www.bbraunusa.com/search/interim.asp. Accessed July 12, 2011.

Hextend^® (6% hetastarch in lactated electrolyte injection) [package insert]. Lake Forest, IL: Hospira, Inc.; September 2008. Available at http://www.hospira.com/Products/Hextend.aspx. Accessed July 12, 2011.

Voluven^® (6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride injection) [package insert]. Lake Forest, IL: Hospira, Inc; 2007. Available at http://products/hospira.com/search/productDetails?listnumber=Voluven&category=Drugs&page=Drug&sort=ndc&order=asc. Accessed July 12, 2011.

Wiedermann

. Hydroxyethyl starch—can the safety problems be ignored? Wien Klin Wochenschr. 2004;116(17-18):583–594.

Davidson

. Renal impact of fluid management with colloids: a comparative review. Eur J Anaesthesiol. 2006;23(9):721–738.

Winkelmayer

Glynn

Levin

Hydroxyethyl starch and change in renal function in patients undergoing coronary artery bypass graft surgery. Kidney Int. 2003;64(3):1046–1049.

10.

Moran

Kapsner

. Acute renal failure associated with elevated plasma oncotic pressure. N Engl J Med. 1987;317(3):150–153.

11.

Cope

Banks

Mauney

Intraoperative hetastarch infusion impairs hemostasis after cardiac operations. Ann Thorac Surg. 1997;63(1):78–82; discussion -3.

12.

Knutson

Deering

Hall

Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery?

Anesth Analg. 2000;90(4):801–807.

13.

Approval memorandum - Voluven. December 20, 2007: U.S. Food and Drug Administration, Center for Drug Evaluation; 2007.

14.

Jacob

Bruegger

Rehm

Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability. Anesthesiology. 2006;104(6):1223–1231.

15.

Moretti

Robertson

El-Moalem

Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration. Anesth Analg. 2003;96(2):611–617, table of contents.

16.

Jungheinrich

Neff

. Pharmacokinetics of hydroxyethyl starch. Clin Pharmacokinet. 2005;44(7):681–699.

17.

Boussekey

Darmon

Langlois

Resuscitation with low volume hydroxyethylstarch 130 kDa/0.4 is not associated with acute kidney injury. Crit Care. 2010;14:R40.

18.

Wiedermann

CJ.

Renal impairment in cardiac surgery patients receiving hydroxyethyl starch. Intensive Care Med. 2004;30(3):519–520; author reply 21.

19.

Kozek-Langenecker

Jungheinrich

Sauermann

The effects of hydroxyethyl starch 130/0.4 (6%) on blood loss and use of blood products in major surgery: a pooled analysis of randomized clinical trials. Anesth Analg. 2008;107(2):382–390.

20.

Magder

Potter

Varennes

Fluids after cardiac surgery: a pilot study of the use of colloids versus crystalloids. Crit Care Med. 2010;38(11):2117–2124.

21.

The Crystalloid versus Hydroxyethyl Starch Trial: protocol for a multi-centre randomised controlled trial of fluid resuscitation with 6% hydroxyethyl starch (130/0.4) compared to 0.9% sodium chloride (saline) in intensive care patients on mortality. Intensive Care Med. 2011;37(5):816–823.