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Does a balanced colloid decrease perioperative blood loss in paediatric cardiac surgery: A double-blinded randomized
Ariane Willems1, Françoise De Groote, Denis Schmartz
1From the Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands (AW), Department of Anaesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS, P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F).
Insights
Balanced colloid fluid therapy did not reduce blood loss or blood product exposure in pediatric cardiac surgery patients. This randomized trial found no significant difference between balanced and saline colloids for peri-operative fluid management.
Area of Science:
- Pediatric Cardiac Surgery
- Fluid Therapy Management
- Colloid Solutions
Background:
- Unbalanced fluid solutions can lead to metabolic acidosis, impaired coagulation, and increased blood loss.
- Peri-operative fluid therapy is critical in pediatric cardiac surgery to maintain hemodynamic stability and minimize complications.
Purpose of the Study:
- To compare the efficacy of balanced colloid versus saline colloid in reducing blood loss and blood product exposure.
- To evaluate the impact of different colloid solutions on peri-operative outcomes in children undergoing cardiac surgery.
Main Methods:
- A double-blinded randomized controlled trial was conducted in a tertiary children's hospital.
- 88 children undergoing cardiac surgery with cardiopulmonary bypass received either saline colloid or balanced-electrolyte colloid for fluid therapy.
- The primary outcome was calculated blood loss until postoperative day 3.
Main Results:
- No significant difference in calculated blood loss was observed between the saline colloid (19.9 ml/kg) and balanced colloid (15.9 ml/kg) groups at postoperative day 3 (P=0.409).
- Secondary outcomes, including bleeding, blood product exposure, coagulation parameters, and length of stay, were similar between the groups.
- Peri-operative fluid therapy with balanced colloid did not demonstrate a reduction in blood loss or transfusion requirements compared to saline colloid.
Conclusions:
- The use of balanced colloid solutions for peri-operative fluid therapy in pediatric cardiac surgery is not associated with decreased blood loss or reduced exposure to blood products compared to saline colloid.
- Current evidence does not support a significant benefit of balanced colloids over saline colloids in this specific patient population and surgical context.
Background:
Unbalanced fluid solutions cause metabolic acidosis and could be associated with impaired coagulation and increased blood loss.
Objective:
To investigate whether the use of a balanced colloid compared with a saline colloid for peri-operative fluid therapy in children undergoing cardiac surgery is associated with decreased blood loss and exposure to blood products.
Design:
Double-blinded randomised controlled trial.
Setting:
Tertiary children's hospital from 2013 to 2016.
Patients:
Children older than 29 days and younger than 3 years admitted for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria were emergency cardiac surgery, moribund (American Society of Anesthesiologists 5), Jehovah's witnesses, coagulopathy, renal failure, liver injury, intracranial haemorrhage and electrolyte disturbances. From the 128 patients eligible, 88 were included in the study.
Intervention:
Random assignment of patients to either a saline colloid (6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) or a balanced-electrolyte colloid (6% hydroxyethyl starch 130/0.4 in an isotonic solution) for CPB priming and intra- and postoperative fluid therapy during the first postoperative 48 h.
Main Outcome Measure:
The primary outcome measure was calculated blood loss until the third postoperative day (POD3).
Results:
A total of 44 patients were included in each study arm. Calculated blood loss at POD3 was not significantly different between the groups (saline colloid 19.9 [IQR 13.8 to 26.1] ml kg-1 versus balanced colloid 15.9 [IQR 9.0 to 25.3 ml kg-1], P = 0.409). Secondary outcomes related to bleeding, exposure to blood products and coagulation were not different between groups. There was also no difference in length of mechanical ventilation, intensive care and hospital length of stay between groups.
Conclusion:
The use of a balanced colloid for peri-operative fluid therapy compared with a saline one is not associated with decreased blood loss or exposure to blood products.
Trial Registration:
EudraCT identifier: 2012-006034-17 and ClinicalTrial.gov identifier: NCT02584868.
