Hydroxyethyl starch 130/0.4 versus modified fluid gelatin for cardiopulmonary bypass priming: the effects on postoperative bleeding and volume expansion needs after elective CABG

Abstract

Concerned about high dose starches and potential coagulopathy, we performed a double blinded randomised prospective study on the influence of gelatine or 6% HES 130/04 pump prime on postoperative blood loss and transfusion requirements after CABG surgery.

Methods: After informed consent, 157 electively scheduled patients were randomly allocated to 6% HES (n=85) or gelatine (n=72) CPB priming. Postoperatively, chest tube drainage was noted hourly during the first 24 hours and every unit of colloid, albumin, FFP or Packed Red Cells needed to maintain hemodynamic stability was carefully registered. Blood losses were standardised as ml blood loss/kg body weight. Three patients in the HES group were excluded from the study because of postoperative haemorrhage of pure surgical origin. Data analysis consisted in unpaired t-test and Fisher exact test where appropriate.

Results: Chest tube drainage was significantly higher at 1 hour in the HES group (2.38 ml/kg vs. 3.15 ml/kg, p = 0.03). At 24 hours, total blood loss was still higher in the HES group without reaching statistical significance (p = 0.07). Albumin supplements occurred more frequently in the HES group between 2 and 3 hours postoperatively (p = 0.02). Total artificial colloid supplement was significantly higher in the gelatin group (13.36 versus 8.96 ml/kg, p < 0.001). There were no differences in the number of packed red cells, fresh frozen plasma or platelets transfused between the two groups.

Conclusion: 6% HES 130/0.4 is a safe alternative to gelatine pump prime with a volume effect persisting longer in the postoperative phase, mandating less volume expansion with artificial colloid during the first 24 postoperative hours and not causing additional allogeneic blood component exposure.