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The relationship between extracorporeal circuit prime, albumin, and postoperative weight gain in children
J Aukerman1, T Voepel-Lewis, L Q Riegger
1Department of Anesthesiology, University of Michigan Health Care Center, Ann Arbor 48109-0211, USA.
Insights
Adding albumin to the extracorporeal (EC) circuit prime and minimizing prime volume reduced postoperative weight gain in pediatric patients undergoing cardiopulmonary bypass (CPB). This finding suggests potential benefits for fluid management in pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Fluid Management
- Extracorporeal Circulation
Background:
- Postoperative weight gain is a common concern in pediatric patients following cardiopulmonary bypass (CPB).
- The composition of the extracorporeal (EC) circuit prime can influence fluid shifts and patient outcomes.
Purpose of the Study:
- To evaluate the impact of albumin versus crystalloid prime on postoperative weight gain in children undergoing CPB.
- To identify predictors of weight gain in this patient population.
Main Methods:
- Retrospective case-controlled study of 76 children (newborn to 4 years) undergoing CPB for congenital heart anomaly correction.
- Matched groups based on age, weight, and surgical repair: Group 1 (albumin prime) vs. Group 2 (crystalloid prime).
Main Results:
- Children receiving albumin prime exhibited significantly less postoperative weight gain on postoperative days 1, 2, and 3 compared to those receiving crystalloid prime (p=0.04 on POD 1).
- Albumin prime and prime volume (mL/kg) were significant predictors of weight gain (p < 0.004), with prime volume being more influential.
- Lower body weight (<7.5 kg) was associated with greater prime volume and increased weight gain.
Conclusions:
- Adding albumin to the EC circuit prime and minimizing prime volume may reduce postoperative weight gain in pediatric CPB patients.
- Further prospective studies are needed to confirm these findings and explore other potential clinical benefits of albumin prime.
Objectives:
This study evaluated postoperative weight gain in children who received albumin versus crystalloid prime for cardiopulmonary bypass (CPB).
Design:
A retrospective case-controlled study. Children whose extracorporeal (EC) circuit prime contained albumin (group 1) were matched with those whose prime contained only crystalloid (group 2) on the basis of age, weight, and surgical repair.
Setting:
A university-based medical center.
Participants:
Seventy-six children (newborn to 4 years of age) who underwent CPB for correction of a congenital heart anomaly from 1993 to 1995. Group 1 underwent surgery from October 1994 to September 1995, and group 2 from February 1993 to September 1994.
Interventions:
None.
Measurements And Main Results:
Group 1 had less weight gain on postoperative days (PODs) 1, 2 and 3 compared with group 2 (p = 0.04 on POD 1). Albumin (grams per milliliter) prime and prime volume in milliliters per kilogram were the best predictors of weight gain (p < 0.004), with prime volume being the more important. Children who weighed less than 7.5 kg received more prime volume and had greater weight gain than children who weighed 7.5 kg or greater on PODs 1, 2, and 3 (p < 0.02).
Conclusion:
Data suggest that adding albumin to the EC circuit prime and minimizing the prime volume will result in less postoperative weight gain. Further prospective study with a larger sample is warranted to determine whether albumin prime offers other clinical benefits.