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Acute plasmapheresis during cardiac surgery: volume replacement by crystalloids versus colloids
1Department of Anesthesiology, Justus-Liebig University Giessen, West Germany.
Journal of Cardiothoracic Anesthesia
|October 1, 1990
Summary
Colloid replacement is preferred over crystalloids for autologous plasma replacement during acute plasmapheresis in cardiac surgery. Colloid solutions combined with hemofiltration best preserve blood components and minimize blood loss.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Critical Care Medicine
Background:
- Acute plasmapheresis (APP) is used for blood conservation in cardiac surgery.
- Optimal replacement fluid for autologous plasma withdrawn during APP requires investigation.
Purpose of the Study:
- To compare the efficacy of colloid versus crystalloid replacement of autologous plasma during APP.
- To evaluate the impact of cell saver (CS) versus hemofiltration (HF) in conjunction with APP and replacement strategies.
Main Methods:
- A randomized study of 60 aortocoronary bypass patients undergoing APP.
- Plasma replacement with either 6% hydroxyethyl starch (HES) or Ringer's solution.
- Concurrent use of cell saver or hemofiltration during cardiopulmonary bypass.
Main Results:
- Colloid replacement required less volume and resulted in a more stable fluid balance compared to crystalloids.
- Patients receiving crystalloid replacement, especially with CS, experienced higher blood loss and required packed red cells.
- Colloid replacement better preserved platelet count, AT-III, fibrinogen, colloid osmotic pressure, albumin, and total protein.
Conclusions:
- Colloid solutions are superior to crystalloids for autologous plasma replacement during APP in cardiac surgery.
- Hemofiltration is more effective than cell saver when used with APP for blood conservation.
- Combined colloid replacement and hemofiltration offer the best strategy for maintaining hemostatic function and minimizing blood loss.