Hydroxyethyl starch in priming fluid for cardiopulmonary bypass

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Pharmacology

Background:

• Hydroxyethyl starch (HES) is a colloidal plasma volume expander.
• HES has physiochemical properties suitable for use as a blood plasma substitute.
• High doses of HES may potentially interfere with blood coagulation.

Purpose of the Study:

• To evaluate the safety and efficacy of hydroxyethyl starch as a priming fluid in cardiopulmonary bypass.
• To determine if the use of HES in cardiopulmonary bypass is associated with excessive bleeding.
• To compare the outcomes of patients receiving HES with historical controls not using HES.

Main Methods:

• Retrospective review of 760 cardiac operations.
• Analysis of perioperative blood loss and bank blood utilization.
• Comparison of outcomes before and after implementing an improved heparin and protamine administration method.

Main Results:

• In 760 cardiac operations, perioperative blood loss was 578 ml and 4.0 units of bank blood were used.
• In 461 patients with improved heparin/protamine management, blood loss decreased to 437 ml and 2.9 units of bank blood were used.
• Re-exploration for bleeding occurred in only 2.0% of patients, comparable to series not using HES.

Conclusions:

• The dose of hydroxyethyl starch used in the priming fluid for cardiopulmonary bypass is not associated with excessive bleeding.
• Hydroxyethyl starch is a safe, effective, and cost-efficient colloidal blood plasma substitute for cardiopulmonary bypass.
• HES offers a viable alternative to albumin in priming fluids for cardiac surgery.