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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 713-722, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RM Sade, MR Stroud, FA Crawford Jr, JM Kratz, JP Dearing and DM Bartles
The ideal priming fluid for cardiopulmonary bypass is not known. We
designed a study to determine whether there are important differences in
the clinical effects of hydroxyethyl starch versus albumin when used in
priming fluid, and in the clinical effects of colloid versus crystalloid
priming fluid. We prospectively randomized 83 adult patients undergoing
coronary artery bypass or valve replacement. All patients were managed by
standardized protocol, and they received one of three priming fluids for
bypass: hydroxyethyl starch (HES), 26 patients; albumin (ALB), 28 patients,
and lactated Ringer's solution (LRS), 29 patients. The groups were
stratified by body weight and type of operation. We measured 41 variables
relating to operative time factors, fluid balance, bleeding, and organ
function (renal, cardiac, and pulmonary) at several time intervals. The LRS
group had a significantly lower colloid osmotic pressure than the other two
groups, and the HES group had a substantially higher blood viscosity.
Although the prothrombin time was significantly lower in the LRS group (p
less than 0.05), the differences were very small and not clinically
important. The platelet count in the HES group was significantly lower than
in the other two groups immediately after bypass, but it was not different
by the time the patients left the operating room. There were no differences
among the groups in chest tube drainage, blood bank usage, or fluid
balance. Postoperatively, the pulmonary shunt fraction was significantly
greater in the LRS group. Body weight increased more in the LRS than in the
HES and ALB groups (p = 0.01). No adverse reaction to the prime solutions
was noted. The differences between the HES and ALB groups--prothrombin
time, platelet count, and blood viscosity--had no apparent clinical
effects; thus, the two may be considered clinically equivalent. The greater
somatic and pulmonary fluid accumulation in the LRS group suggests that
colloid is preferable to crystalloid in priming fluid.
ARTICLES
A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass
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