Perioperative volume replacement in children undergoing cardiac surgery: albumin versus hydroxyethyl starch 130/0.4.

OBJECTIVE

To compare 4% albumin with 6% hydroxyethyl starch (HES) 130/0.4 in terms of perioperative blood loss and intraoperative fluid requirements in children undergoing cardiac surgery.

DESIGN

Prospective randomized study.

SETTING

Single University Hospital.

PATIENTS

Pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.

INTERVENTIONS

One hundred nineteen children were randomized to receive up to 50 mL.kg of either 4% albumin (Alb: n = 59) or 6% HES 130/0.4 (HES: n = 60) for intraoperative fluid volume replacement including the cardiopulmonary bypass priming fluid. Ringer's lactate was used for further intraoperative volume needs. Monitoring, anesthetic, and surgical techniques were standardized. Packed red blood cells were administered according to a strict transfusion protocol. Intra- and postoperative blood loss were measured and also calculated from children's estimated blood volume, pre- and postoperative hematocrit, and volume of transfused packed red blood cells.

MEASUREMENTS AND MAIN RESULTS

Volume of colloid used intraoperatively was similar in both groups (median [interquartiles]) (Alb: 50 [45-50] mL x kg; HES: 50 [37-50] mL x kg). Measured and calculated blood loss were not different between groups, but a higher number of children in the albumin group required allogeneic blood transfusion (78% vs. 57%; difference between proportions: 0.213; 95% confidence interval: 0.05-0.38; p = 0.0188). Intraoperative fluid balance was lower in the HES group (Alb 23 [11-39] mL x kg; HES: 12 [-5-30] mL x kg; p = 0.005). Postoperative outcome was not different between groups.

CONCLUSIONS

In children undergoing cardiac surgery, 6% HES 130/0.4 may represent an interesting alternative to 4% albumin for intraoperative fluid volume replacement because of its lower cost.