Related Experiment Video
Updated: Jul 5, 2026
09:06
Preparation of DNA-crosslinked Polyacrylamide Hydrogels
Published on: August 27, 2014
Low molecular starch versus gelatin plasma expander during CPB: does it make a difference?
Ricardo H Boks1, Marianne J Wijers, Jan Hofland
1Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands. rhboks@planet.nl
Perfusion
|April 18, 2008
Summary
Low molecular starch (LMSRL) requires fewer plasma expanders during cardiopulmonary bypass (CPB) priming compared to gelatin plasma expanders (GPE). While LMSRL showed lower colloid osmotic pressure, it remains clinically safe for cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Non-protein plasma expanders pose risks of allergic reactions.
- Gelatin plasma expanders are routinely used for cardiopulmonary bypass (CPB) priming.
- Current anesthesia practices utilize high molecular starch with Ringer Lactate (RL) and low molecular starch (130/0.4 kDalton) in the Intensive Care Unit (ICU).
Purpose of the Study:
- To evaluate the feasibility of using low molecular starch with RL (LMSRL) versus gelatin plasma expanders (GPE) for priming CPB circuits in cardiac surgery patients.
- To compare clinical outcomes between LMSRL and GPE in a randomized prospective trial.
Main Methods:
- A randomized prospective trial involving 180 adult patients undergoing primary valve or coronary artery bypass graft (CABG) surgery.
- Patients were stratified by oxygenator type (Capiox RX-25, CML Duo, Quadrox-D) and randomized into LMSRL or GPE groups.
- Key parameters compared included hematocrit, hemoglobin, platelet count, activated clotting time (ACT), lactate, colloid osmotic pressure (COP), blood loss, transfusion needs, urine output, ICU stay, and average trans-oxygenator fluid resistance (AFR).
Main Results:
- The LMSRL group demonstrated significantly lower colloid osmotic pressure (COP) (18 mmHg +/- 0.2 vs. 20 mmHg +/- 0.2, p < 0.0001) and reduced total plasma expander usage (3059 ml +/- 77 vs. 3846 ml +/- 98, p < 0.001).
- No significant differences were observed in other measured parameters between the groups.
- A lower average trans-oxygenator fluid resistance (AFR) was noted for the Capiox RX-25 oxygenator in the LMSRL group (p < 0.02).
Conclusions:
- Low molecular starch plasma expanders lead to a reduced overall need for plasma expanders in CPB priming.
- The observed decrease in COP with LMSRL was not clinically significant as it remained above the threshold of 17 mmHg.
- Low molecular starch presents a viable alternative for priming cardiopulmonary bypass circuits in cardiac surgery.
