Hetastarch as a prime for cardiopulmonary bypass

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Hematology

Background:

• Cardiopulmonary bypass (CPB) requires effective plasma volume expanders.
• Albumin and hetastarch are commonly used colloid osmotic agents.
• Evaluating the impact of different prime solutions on perioperative outcomes is crucial.

Purpose of the Study:

• To compare the effects of hetastarch versus albumin prime on perioperative laboratory values and outcomes in myocardial revascularization.
• To assess the cost-effectiveness of hetastarch as a CPB prime solution.

Main Methods:

• A prospective study involving 37 patients undergoing myocardial revascularization with hetastarch prime.
• Comparison with a historical cohort of 42 patients who received albumin-containing prime.
• Analysis of postoperative laboratory values including platelet counts, hemoglobin, fibrinogen, and coagulation times.
• Evaluation of chest tube drainage and blood usage.

Main Results:

• Patients receiving hetastarch prime exhibited significantly lower postoperative platelet counts (p < 0.02).
• No significant differences were observed in chest tube drainage, blood transfusion requirements, plasma hemoglobin, fibrinogen levels, or coagulation times between the groups.
• Hetastarch prime demonstrated substantial cost savings ($119.50/patient) compared to albumin prime ($321.35/patient).

Conclusions:

• Hetastarch can be used as a prime for CPB in myocardial revascularization.
• While hetastarch may lead to reduced platelet counts, it does not appear to compromise other critical perioperative hemostatic or clinical outcomes.
• The use of hetastarch offers a significant cost advantage over albumin in CPB procedures.