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Effects of colloid-based (hydroxyethylstarch 6% 130/0.42, gelafundin 4%) and crystalloid-based volume regimes in
Thomas Datzmann1,2, Theresa Völtl1, Nicola Ortner1
1Department of Anesthesiology, University Hospital Ulm, Ulm, Germany.
Insights
Hydroxyethylstarch (HES) restriction shifted volume management to gelatin (GELA) or crystalloids (CRYS) in cardiac surgery. Crystalloid monotherapy reduced blood loss and transfusions without impacting mortality or acute kidney injury (AKI).
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Nephrology
Background:
- Hydroxyethylstarch (HES) use is restricted, leading to increased use of gelatin (GELA) and crystalloid (CRYS) for fluid management in cardiac surgery.
- This shift impacts volume replacement strategies in patients undergoing procedures like coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the effects of GELA or CRYS monotherapy on mortality, acute kidney injury (AKI), blood loss, and transfusion requirements in cardiac surgery.
- To compare outcomes between HES, GELA, and CRYS monotherapy groups.
Main Methods:
- Retrospective study of 1,540 cardiac surgery patients with CABG.
- Analysis of three groups: HES (n=938), GELA (n=397), and CRYS (n=205).
- Data analyzed using multiple regression models to assess outcomes.
Main Results:
- No significant differences in mortality or AKI were observed between HES, GELA, and CRYS groups.
- CRYS monotherapy resulted in significantly lower blood loss and transfusion requirements (PRBCs, PCs, FFP) compared to HES and GELA.
- Patients receiving CRYS had shorter mechanical ventilation times and earlier ICU discharge.
Conclusions:
- Crystalloid monotherapy in cardiac surgery is associated with reduced blood loss and transfusions without compromising mortality or AKI.
- Colloid administration warrants critical consideration; further research on GELA in cardiac surgery is recommended.
Background:
The restriction of hydroxyethylstarch (HES) necessitated changes in volume management in cardiac surgery, increasing the use of gelatin (GELA) and crystalloid (CRYS) mono strategies.
Methods:
This retrospective study evaluated the effects of changed volume replacement management to a GELA or CRYS mono therapy on mortality, acute kidney injury (AKI), blood loss, and transfusion in cardiac surgery patients with at least one coronary artery bypass grafting (CABG) at a university hospital. Three groups (HES n=938, GELA n=397, CRYS n=205) were derived from 1,540 patients with complete data sets. Data were analyzed by multiple regression models.
Results:
Patients had similar risk profiles, comorbidities, and preoperative routine diagnostics prior to surgery. No difference was observed in mortality and AKI. HES treated patients showed highest blood loss, followed by GELA while CRYS patients had the lowest (P<0.0001). Patients in the HES group had highest transfusion of packed red blood cells (PRBCs) and platelet concentrates (PCs), followed by GELA, whereas CRYS had the lowest (P<0.0001). Fresh frozen plasma (FFP) transfusion, administration of fibrinogen, and prothrombin complex concentrates (PCCs) were highest in HES group. CRYS showed the shortest time of mechanical ventilation (P<0.0001) and left the intensive care unit (ICU) significantly earlier (P<0.0001). Multivariable regression analysis found that colloid volume significantly predicted hospital mortality and renal replacement therapy (RRT), but not AKI.
Conclusions:
Administration of crystalloids without any colloid showed no differences in mortality or AKI, but less blood loss and transfusion. Colloids should be considered critically and further studies should investigate effects of GELA in cardiac surgery.
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