Comparison of the effects of gelatin, Ringer's solution and a modern hydroxyl ethyl starch solution after coronary artery bypass graft surgery : cardiovascular topic

S.M Alavi,B Baharestani,T Babaei,B Baharvand Ahmadi

doi:10.5830/cvja-2012-026

Abstract

The aim of this study was to compare the effect of 6% hydroxyl ethyl starch solution with 4% gelatin and Ringer's solutions on the haemodynamic stability of patients after coronary artery bypass graft (CABG) surgery and immediately after discontinuation of cardiopulmonary bypass (CPB). This was a randomised, double-blind clinical trial of 92 patients who were candidates for on-pump CABG. After discontinuation of CPB, all patients were transferred to the intensive care unit (ICU) and divided randomly into three groups. The first group received Ringer's solution, the second group 4% gelatin, and the third 6% hydroxyl ethyl starch (HES) solution (Voluven). Haemodynamic parameters such as heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac output and the presence of arrhythmias were documented. The volume needed for maintaining normal blood pressure and central venous pressure in the range of 10-14 mmHg was less in the HES group than in the other groups. The volume was similar however in the gelatin and Ringer's groups in the first 24 hours after surgery. Urinary output in the first four and 24 hours after surgery were significantly higher in the HES group than in the other two groups. Mean creatinine levels were significantly lower in the HES group. HES (6%) had a better volume-expanding effect than gelatin (4%) and Ringer's solutions, and its short-term effects on renal function were also better than gelatin and Ringer's solutions.

Highlights

MethodsThis was a prospective, randomised, double-blind clinical trial in 92 patients who were candidates for on-pump coronary artery bypass graft (CABG)
The volume needed for maintaining normal blood pressure and central venous pressure in the range of 10–14 mmHg was less in the hydroxyl ethyl starch (HES) group than in the other groups
There were no significant differences in systolic and diastolic blood pressure between the three groups, and haemoglobin, blood urea nitrogen (BUN), creatinine, Na and K levels, partial thromboplastin time (PTT), and international normalised ratio (INR) were same in the three groups

Summary

Methods

This was a prospective, randomised, double-blind clinical trial in 92 patients who were candidates for on-pump CABG. After infusion of 300 IU/ kg heparin, the patient went on-pump and the activated clotting time (ACT) was above 480 s, mean arterial pressure 60–70 mmHg, haematocrit level was 22–27%, and the temperature was set at 32°C. MAP: mean arterial pressure, HR: heart rate, CVP: central venous pressure pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac index and the presence of arrhythmias were documented. Other independent variables such as urinary output, serum electrolytes and serum creatinine levels were measured immediately after discontinuation of CPB, before transferring the patient to the ICU, immediately after arriving in ICU, and after two, four, six, 12 and 24 hours in ICU. The data were put into spreadsheets and comparison of variables between groups was done using Chi-squared or ANOVA tests

Results

Discussion

Conclusion