Abstract
IntroductionSix percent hydroxyethyl starch (HES) 130/0.4 is considered an alternative to human albumin (HA) and crystalloids for volume replacement in children undergoing cardiac surgery. In this large propensity-matched analysis, we aimed to assess the efficacy and safety of replacing HA with HES for intraoperative volume therapy in children undergoing cardiac surgery with cardiopulmonary bypass (CPB).MethodsWe retrospectively reviewed our database, including children who underwent cardiac surgery between January 2002 and December 2010. Four percent HA was used until 2005; it was replaced by HES thereafter. Demographic data, intra- and postoperative blood loss and blood component transfusions were recorded, together with the incidence of postoperative complications and mortality. We performed a propensity-matched analysis using 13 possible confounding factors to compare children who received either HES or HA intraoperatively. The primary objectives included the effects of both fluids on intraoperative fluid balance (difference between fluids in and fluids out (efficacy)) and blood loss and exposure to allogeneic blood products (safety). Secondary safety outcomes were mortality and the incidence of postoperative renal dysfunction.ResultsOf 1,832 children reviewed, 1,495 were included in the analysis. Intraoperative use of HES was associated with a less positive fluid balance. Perioperative blood loss, volume of red blood cells and fresh frozen plasma administered, as well as the number of children who received transfusions, were also significantly lower in the HES group. No difference was observed regarding the incidence of postoperative renal failure requiring renal replacement therapy or of morbidity and mortality.ConclusionsThese results confirm that the use of HES for volume replacement in children during cardiac surgery with CPB is as safe as HA. In addition, its use might be associated with less fluid accumulation. Further large studies are needed to assess whether the reduction in fluid accumulation could have a significant impact on postoperative morbidity and mortality.
Highlights
Six percent hydroxyethyl starch (HES) 130/0.4 is considered an alternative to human albumin (HA) and crystalloids for volume replacement in children undergoing cardiac surgery
We excluded 83 children because relevant data were missing, 82 because fresh frozen plasma (FFP) was used primarily in the cardiopulmonary bypass (CPB) prime, 7 who were in a moribund state and 5 Jehovah’s witnesses
Regarding the primary safety objective, our results indicate that the use of 6% HES 130/0.4 was associated with a reduced exposure to Red blood cells (RBC) and FFP transfusion in the studied population
Summary
Six percent hydroxyethyl starch (HES) 130/0.4 is considered an alternative to human albumin (HA) and crystalloids for volume replacement in children undergoing cardiac surgery. In this large propensity-matched analysis, we aimed to assess the efficacy and safety of replacing HA with HES for intraoperative volume therapy in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Human albumin (HA) and crystalloids remain first choices for CPB priming and volume replacement in the perioperative period of pediatric cardiac surgery [6]. In a prospective, randomized, double-blind study including about 7,000 patients, administration of 6% HES 130/0.4 was associated with an increased need for renal replacement therapy compared with use of isotonic saline [11]. The results of these studies led to an intense, and sometimes emotional, debate, they should be interpreted with caution, taking into account the clinical context [13], and cannot be transposed to the pediatric cardiac population
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have