Effect of 6% Hydroxyethyl Starch 130/0.4 As a Priming Solution on Coagulation and Inflammation Following Complex Heart Surgery

Overview

Journal Yonsei Med J

Specialty General Medicine

Date 2014 Apr 11

PMID 24719128

Citations 6

Authors

Jang-Eun Cho

Jae-Kwang Shim

Jong-Wook Song

Jong-Won Song

Hye-Won Lee

Dong-Hwan Kim

Young-Lan Kwak

Affiliations

Soon will be listed here.

Abstract

Purpose: Prolonged duration of cardiopulmonary bypass aggravates the degree of inflammation and coagulopathy. We investigated the influence of 6% hydroxyethyl starch (HES) 130/0.4 on coagulation and inflammation compared with albumin when used for both cardiopulmonary bypass priming and perioperative fluid therapy in patients undergoing complex valvular heart surgery.

Materials And Methods: Fifty four patients were randomly allocated into albumin-HES, albumin-nonHES, and HES-HES groups. The cardiopulmonary bypass circuit was primed with 5% albumin in the albumin-HES and albumin-nonHES group, and with HES in the HES-HES group. As perioperative fluid, only plasmalyte was used in the albumin-nonHES group whereas HES was used up to 20 mL/kg in the albumin-HES and albumin-HES group. Serial assessments of coagulation profiles using the rotational thromboelastometry and inflammatory markers (tissue necrosis factor-α, interleukin-6, and interleukin-8) were performed.

Results: Patients' characteristics and the duration of cardiopulmonary bypass (albumin-HES; 137±34 min, HES-HES; 136±47 min, albumin-nonHES; 132±39 min) were all similar among the groups. Postoperative coagulation profiles demonstrated sporadic increases in clot formation time and coagulation time, without any differences in the actual amount of perioperative bleeding and transfusion requirements among the groups. Also, inflammatory markers showed significant activation after cardiopulmonary bypass without any differences among the groups.

Conclusion: Even in the presence of prolonged duration of cardiopulmonary bypass, HES seemed to yield similar influence on the ensuing coagulopathy and inflammatory response when used for priming and perioperative fluid therapy following complex valvular heart surgery compared with conventional fluid regimen including albumin and plasmalyte.

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References

Westphal M, James M, Kozek-Langenecker S, Stocker R, Guidet B, Van Aken H . Hydroxyethyl starches: different products--different effects. Anesthesiology. 2009; 111(1):187-202. DOI: 10.1097/ALN.0b013e3181a7ec82. View

Apostolakis E, Koletsis E, Baikoussis N, Siminelakis S, Papadopoulos G . Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. J Cardiothorac Surg. 2010; 5:1. PMC: 2823729. DOI: 10.1186/1749-8090-5-1. View

Sander M, Spies C, Martiny V, Rosenthal C, Wernecke K, von Heymann C . Mortality associated with administration of high-dose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis. Crit Care. 2010; 14(4):R148. PMC: 2945131. DOI: 10.1186/cc9216. View

Ebinger T, Ruland A, Lakner M, Schwaiger M . Validity, regulatory registration and approval of ROTEM thromboelastometry. Blood Coagul Fibrinolysis. 2010; 21(1):106-7. DOI: 10.1097/MBC.0b013e3283306e28. View

Niemi T, Kuitunen A . Hydroxyethyl starch impairs in vitro coagulation. Acta Anaesthesiol Scand. 1998; 42(9):1104-9. DOI: 10.1111/j.1399-6576.1998.tb05385.x. View

Choi Y, Shim J, Hong S, Kim J, Kwak Y . Comparing the effects of 5% albumin and 6% hydroxyethyl starch 130/0.4 on coagulation and inflammatory response when used as priming solutions for cardiopulmonary bypass. Minerva Anestesiol. 2010; 76(8):584-91. View

Haynes G, Navickis R, Wilkes M . Albumin administration--what is the evidence of clinical benefit? A systematic review of randomized controlled trials. Eur J Anaesthesiol. 2003; 20(10):771-93. DOI: 10.1017/s0265021503001273. View

Theusinger O, Wanner G, Emmert M, Billeter A, Eismon J, Seifert B . Hyperfibrinolysis diagnosed by rotational thromboelastometry (ROTEM) is associated with higher mortality in patients with severe trauma. Anesth Analg. 2011; 113(5):1003-12. DOI: 10.1213/ANE.0b013e31822e183f. View

Tanaka K, Bolliger D, Vadlamudi R, Nimmo A . Rotational thromboelastometry (ROTEM)-based coagulation management in cardiac surgery and major trauma. J Cardiothorac Vasc Anesth. 2012; 26(6):1083-93. DOI: 10.1053/j.jvca.2012.06.015. View

10.

Vincent J, Wilkes M, Navickis R . Safety of human albumin--serious adverse events reported worldwide in 1998-2000. Br J Anaesth. 2003; 91(5):625-30. DOI: 10.1093/bja/aeg233. View

11.

Van der Linden P, De Hert S, Deraedt D, Cromheecke S, De Decker K, Paep R . Hydroxyethyl starch 130/0.4 versus modified fluid gelatin for volume expansion in cardiac surgery patients: the effects on perioperative bleeding and transfusion needs. Anesth Analg. 2005; 101(3):629-634. DOI: 10.1213/01.ANE.0000175216.53374.27. View

12.

Leemann H, Lustenberger T, Talving P, Kobayashi L, Bukur M, Brenni M . The role of rotation thromboelastometry in early prediction of massive transfusion. J Trauma. 2010; 69(6):1403-8. DOI: 10.1097/TA.0b013e3181faaa25. View

13.

Roullet S, Pillot J, Freyburger G, Biais M, Quinart A, Rault A . Rotation thromboelastometry detects thrombocytopenia and hypofibrinogenaemia during orthotopic liver transplantation. Br J Anaesth. 2010; 104(4):422-8. DOI: 10.1093/bja/aeq022. View

14.

Zarychanski R, Abou-Setta A, Turgeon A, Houston B, McIntyre L, Marshall J . Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA. 2013; 309(7):678-88. DOI: 10.1001/jama.2013.430. View

15.

Wilkes M, Navickis R, Sibbald W . Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. Ann Thorac Surg. 2001; 72(2):527-33; discussion 534. DOI: 10.1016/s0003-4975(01)02745-x. View

16.

Adrian K, Mellgren K, Skogby M, Friberg L, Mellgren G, Wadenvik H . The effect of albumin priming solution on platelet activation during experimental long-term perfusion. Perfusion. 1998; 13(3):187-91. DOI: 10.1177/026765919801300306. View

17.

Kuitunen A, Hynynen M, Vahtera E, Salmenpera M . Hydroxyethyl starch as a priming solution for cardiopulmonary bypass impairs hemostasis after cardiac surgery. Anesth Analg. 2004; 98(2):291-297. DOI: 10.1213/01.ANE.0000096006.60716.F6. View

18.

Karkouti K, McCluskey S, Syed S, Pazaratz C, Poonawala H, Crowther M . The influence of perioperative coagulation status on postoperative blood loss in complex cardiac surgery: a prospective observational study. Anesth Analg. 2010; 110(6):1533-40. DOI: 10.1213/ANE.0b013e3181db7991. View

19.

Rackow E, FALK J, FEIN I, Siegel J, Packman M, Haupt M . Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med. 1983; 11(11):839-50. View

20.

Paparella D, Brister S, Buchanan M . Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Med. 2004; 30(10):1873-81. DOI: 10.1007/s00134-004-2388-0. View