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J Thorac Cardiovasc Surg 2005;130:287-294
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Cold-induced fluid extravasation during cardiopulmonary bypass in piglets can be counteracted by use of iso-oncotic prime

^a Department of Anesthesia and Intensive Care, Department of Heart Disease, University of Bergen, Haukeland University Hospital, Bergen, Norway
^b Section for Cardiac Surgery, Department of Heart Disease, University of Bergen, Haukeland University Hospital, Bergen, Norway

Received for publication August 9, 2004; revisions received September 23, 2004; accepted for publication October 13, 2004.

^_* Address for reprints: Paul Husby, MD, PhD, Department of Anesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway (Email: paul.husby{at}kir.uib.no).

OBJECTIVE: Hypothermic cardiopulmonary bypass is associated with increased fluid extravasation. This study aimed to compare whether iso-oncotic priming solutions, in contrast to crystalloids, could reduce the cold-induced fluid extravasation during cardiopulmonary bypass in piglets.

METHODS: Three groups were studied: the control group (CT group; n = 10), the albumin group (Alb group; n = 7), and the hydroxyethyl starch group (HES group; n = 7). Prime (1000 mL) and supplemental fluid were acetated Ringer solution, 4% albumin, and 6% hydroxyethyl starch, respectively. After 1 hour of normothermic cardiopulmonary bypass, hypothermic cardiopulmonary bypass (cooling to 28°C within 15 minutes) was initiated and continued to 90 minutes. Fluid needs, plasma volume, changes in colloid osmotic pressure in plasma and interstitial fluid, hematocrit levels, and tissue water content were recorded, and protein masses and fluid extravasation rates were calculated.

RESULTS: Colloid osmotic pressure in plasma decreased immediately after the start of cardiopulmonary bypass in the CT group but remained stable in the Alb and HES groups. Colloid osmotic pressure in interstitial fluid tended to decrease in the CT group and remained unchanged in the Alb group, whereas a slight increase was observed in the HES group. Immediately after the start of cooling, fluid extravasation rates increased from 0.15 ± 0.10 to 0.64 ± 0.12 mL · kg^–1 · min^–1 in the CT group, whereas no such increase was observed in the Alb and HES groups. The changes in fluid extravasation rates were reflected by corresponding changes in tissue water content.

CONCLUSION: The use of albumin or hydroxyethyl starch as prime to preserve the colloid osmotic pressure during cardiopulmonary bypass causes a reduction in the cold-induced fluid extravasation compared with that seen with crystalloids. Albumin seems more effective than hydroxyethyl starch to limit cold-induced fluid shifts during cardiopulmonary bypass.

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