The Effects of Albumin 20% and Hydroxyethyl Starch 6% on Bleeding and Interleukin-6 Levels as Priming Solutions for Cardiopulmonary Bypass: A Randomized Controlled Trial
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Abstract
Background: Cardiopulmonary bypass (CPB) can adversely affect coagulation and systemic inflammatory response. Given that the optimal strategy for priming CPB in cardiac surgery remains a matter of debate, this study aimed to investigate the effects of albumin 20% and hydroxyethyl starch 6% as priming solutions on bleeding and interleukin-6 (IL-6) levels during CPB.
Methods: This randomized clinical trial involved 40 patients undergoing coronary artery bypass surgery at Shahid Chamran Hospital between July 2021 and July 2022. Participants were assigned to 2 groups: the first group received 50 mL of albumin 20% as the priming solution for the CPB circuit, while the second group received 500 mL of hydroxyethyl starch 6%. Bleeding and IL-6 levels were assessed before and after the intervention.
Results: The albumin group comprised 80.0% men and 20.0% women, with a mean age of 66.45±5.84 years. The hydroxyethyl starch 6% group consisted of 85.0% men and 15.0% women, with a mean age of 63.05±5.92 years (P>0.05). The findings revealed that 12 hours after CPB, the IL-6 level in the hydroxyethyl starch 6% group (mean: 171.6±77.71 pg/mL) was significantly higher than that in the albumin group (mean: 105.8±36.45 pg/mL; P=0.002). At 48 hours after CPB, the mean bleeding was not significantly different between the groups (P=0.950).
Conclusion: Albumin 20% was more effective than hydroxyethyl starch 6% concerning IL-6 levels. However, no significant differences in bleeding were observed between the groups at 48 hours post-CPB.
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2. Ljunggren M, Sköld A, Dardashti A, Hyllén S. The use of mannitol in cardiopulmonary bypass prime solution-Prospective randomized double-blind clinical trial. Acta Anaesthesiol Scand 2019;63:1298-1305.
3. Base EM, Standl T, Lassnigg A, Skhirtladze K, Jungheinrich C, Gayko D, Hiesmayr M. Efficacy and safety of hydroxyethyl starch 6% 130/0.4 in a balanced electrolyte solution (Volulyte) during cardiac surgery. J Cardiothorac Vasc Anesth 2011;25:407-414.
4. Bethlehem I, Wierda K, Visser C, Jekel L, Koopmans M, Kuiper MA. Influence of Two Colloidal Extracorporeal Primes on Coagulation of Cardiac Surgical Patients: A Prospectively Randomized Open-Label Pilot Trial. J Extra Corpor Technol 2014;46:293-299.
5. Yanartas M, Baysal A, Aydın C, Ay Y, Kara I, Aydın E, Cevirme D, Köksal C, Sunar H. The effects of tranexamic acid and 6% hydroxyethyl starch (HES) solution (130/0.4) on postoperative bleeding in coronary artery bypass graft (CABG) surgery. Int J Clin Exp Med 2015;8:5959-5971.
6. Malmqvist G, Claesson Lingehall H, Appelblad M, Svenmarker S. Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids. Perfusion 2019;34:130-135.
7. Kamalipour M, Akhondzadeh S. Cardiovascular effects of saffron: an evidence-based review. J Tehran Heart Cent 2011;6:59-61.
8. Gallandat Huet RC, Siemons AW, Baus D, van Rooyen-Butijn WT, Haagenaars JA, van Oeveren W, Bepperling F. A novel hydroxyethyl starch (Voluven) for effective perioperative plasma volume substitution in cardiac surgery. Can J Anaesth 2000;47:1207-1215.
9. Datzmann T, Hoenicka M, Reinelt H, Liebold A, Gorki H. Influence of 6% Hydroxyethyl Starch 130/0.4 Versus Crystalloid Solution on Structural Renal Damage Markers After Coronary Artery Bypass Grafting: A Post Hoc Subgroup Analysis of a Prospective Trial. J Cardiothorac Vasc Anesth 2018;32:205-211.
10. Lockwood DN, Bullen C, Machin SJ. A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah's Witness. Anaesthesia 1988;43:391-393.
11. Waitzinger J, Bepperling F, Pabst G, Opitz J. Hydroxyethyl starch (HES) [130/0.4], a new HES specification: pharmacokinetics and safety after multiple infusions of 10% solution in healthy volunteers. Drugs R D 2003;4:149-157.
12. Choi YS, Shim JK, Hong SW, Kim JC, Kwak YL. Comparing the effects of 5% albumin and 6% hydroxyethyl starch 130/0.4 on coagulation and inflammatory response when used as priming solutions for cardiopulmonary bypass. Minerva Anestesiol 2010;76:584-591.
13. Sheikhi B, Rezaei Y, Baghaei Vaji F, Fatahi M, Hosseini Yazdi M, Totonchi Z, Banar S, Peighambari MM, Hosseini S, Mestres CA. Comparison of six percent hydroxyethyl starch 130/0.4 and ringer's lactate as priming solutions in patients undergoing isolated open heart valve surgery: A double-blind randomized controlled trial. Perfusion 2023:2676591231222135.
14. Gu YJ, Boonstra PW. Selection of priming solutions for cardiopulmonary bypass in adults. Multimed Man Cardiothorac Surg 2006;2006:mmcts.2005.001198.
15. Hosseinzadeh Maleki M, Derakhshan P, Rahmanian Sharifabad A, Amouzeshi A. Comparing the Effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on Renal Function as Priming Solutions for Cardiopulmonary Bypass: A Randomized Double Blind Clinical Trial. Anesth Pain Med 2016;6:e30326.
16. Rehm M, Orth V, Scheingraber S, Kreimeier U, Brechtelsbauer H, Finsterer U. Acid-base changes caused by 5% albumin versus 6% hydroxyethyl starch solution in patients undergoing acute normovolemic hemodilution: a randomized prospective study. Anesthesiology 2000;93:1174-1183.
17. Niemi T, Schramko A, Kuitunen A, Kukkonen S, Suojaranta-Ylinen R. Haemodynamics and acid-base equilibrium after cardiac surgery: comparison of rapidly degradable hydroxyethyl starch solutions and albumin. Scand J Surg 2008;97:259-265.
18. Jacob M, Fellahi JL, Chappell D, Kurz A. The impact of hydroxyethyl starches in cardiac surgery: a meta-analysis. Crit Care 2014;18:656.
19. Holloway DS, Summaria L, Sandesara J, Vagher JP, Alexander JC, Caprini JA. Decreased platelet number and function and increased fibrinolysis contribute to postoperative bleeding in cardiopulmonary bypass patients. Thromb Haemost 1988;59:62-67.
20. Dieterich HJ, Weissmüller T, Rosenberger P, Eltzschig HK. Effect of hydroxyethyl starch on vascular leak syndrome and neutrophil accumulation during hypoxia. Crit Care Med 2006;34:1775-1782.
21. Yeh T Jr, Parmar JM, Rebeyka IM, Lofland GK, Allen EL, Dignan RJ, Dyke CM, Wechsler AS. Limiting edema in neonatal cardiopulmonary bypass with narrow-range molecular weight hydroxyethyl starch. J Thorac Cardiovasc Surg 1992;104:659-665.
22. Reiterer C, Kabon B, Zotti O, Obradovic M, Kurz A, Fleischmann E. Effect of goal-directed crystalloid- versus colloid-based fluid strategy on tissue oxygen tension: a randomised controlled trial. Br J Anaesth 2019;123:768-776.
23. Lee MJ, Tannenbaum C, Mao G, Jia Y, Leung S, Yilmaz HO, Ince I, Soltesz E, Duncan AE. Effect of 6% Hydroxyethyl Starch 130/0.4 on Inflammatory Response and Pulmonary Function in Patients Having Cardiac Surgery: A Randomized Clinical Trial. Anesth Analg 2021;133:906-914.
24. Van der Linden P, De Villé A, Hofer A, Heschl M, Gombotz H. Six percent hydroxyethyl starch 130/0.4 (Voluven®) versus 5% human serum albumin for volume replacement therapy during elective open-heart surgery in pediatric patients. Anesthesiology 2013;119:1296-1309.
25. Tiryakioğlu O, Yildiz G, Vural H, Goncu T, Ozyazicioglu A, Yavuz S. Hydroxyethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial). J Cardiothorac Surg 2008;3:45.
26. Wei L, Li D, Sun L. The comparison of albumin and 6% hydroxyethyl starches (130/0.4) in cardiac surgery: a meta-analysis of randomized controlled clinical trials. BMC Surg 2021;21:342.
27. Gurbuz HA, Durukan AB, Salman N, Tavlasoglu M, Durukan E, Ucar Hİ, Yorgancioglu C. Hydroxyethyl starch 6%, 130/0.4 vs. a balanced crystalloid solution in cardiopulmonary bypass priming: a randomized, prospective study. J Cardiothorac Surg 2013;8:71.
28. Xian-Yu CY, Xu JB, Ma YT, Deng NJ, Tao YT, Li HJ, Gao TY, Yang JY, Zhang C. Management of priming fluids in cardiopulmonary bypass for adult cardiac surgery: network meta-analysis. Ann Med 2023;55:2246996.
2. Ljunggren M, Sköld A, Dardashti A, Hyllén S. The use of mannitol in cardiopulmonary bypass prime solution-Prospective randomized double-blind clinical trial. Acta Anaesthesiol Scand 2019;63:1298-1305.
3. Base EM, Standl T, Lassnigg A, Skhirtladze K, Jungheinrich C, Gayko D, Hiesmayr M. Efficacy and safety of hydroxyethyl starch 6% 130/0.4 in a balanced electrolyte solution (Volulyte) during cardiac surgery. J Cardiothorac Vasc Anesth 2011;25:407-414.
4. Bethlehem I, Wierda K, Visser C, Jekel L, Koopmans M, Kuiper MA. Influence of Two Colloidal Extracorporeal Primes on Coagulation of Cardiac Surgical Patients: A Prospectively Randomized Open-Label Pilot Trial. J Extra Corpor Technol 2014;46:293-299.
5. Yanartas M, Baysal A, Aydın C, Ay Y, Kara I, Aydın E, Cevirme D, Köksal C, Sunar H. The effects of tranexamic acid and 6% hydroxyethyl starch (HES) solution (130/0.4) on postoperative bleeding in coronary artery bypass graft (CABG) surgery. Int J Clin Exp Med 2015;8:5959-5971.
6. Malmqvist G, Claesson Lingehall H, Appelblad M, Svenmarker S. Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids. Perfusion 2019;34:130-135.
7. Kamalipour M, Akhondzadeh S. Cardiovascular effects of saffron: an evidence-based review. J Tehran Heart Cent 2011;6:59-61.
8. Gallandat Huet RC, Siemons AW, Baus D, van Rooyen-Butijn WT, Haagenaars JA, van Oeveren W, Bepperling F. A novel hydroxyethyl starch (Voluven) for effective perioperative plasma volume substitution in cardiac surgery. Can J Anaesth 2000;47:1207-1215.
9. Datzmann T, Hoenicka M, Reinelt H, Liebold A, Gorki H. Influence of 6% Hydroxyethyl Starch 130/0.4 Versus Crystalloid Solution on Structural Renal Damage Markers After Coronary Artery Bypass Grafting: A Post Hoc Subgroup Analysis of a Prospective Trial. J Cardiothorac Vasc Anesth 2018;32:205-211.
10. Lockwood DN, Bullen C, Machin SJ. A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah's Witness. Anaesthesia 1988;43:391-393.
11. Waitzinger J, Bepperling F, Pabst G, Opitz J. Hydroxyethyl starch (HES) [130/0.4], a new HES specification: pharmacokinetics and safety after multiple infusions of 10% solution in healthy volunteers. Drugs R D 2003;4:149-157.
12. Choi YS, Shim JK, Hong SW, Kim JC, Kwak YL. Comparing the effects of 5% albumin and 6% hydroxyethyl starch 130/0.4 on coagulation and inflammatory response when used as priming solutions for cardiopulmonary bypass. Minerva Anestesiol 2010;76:584-591.
13. Sheikhi B, Rezaei Y, Baghaei Vaji F, Fatahi M, Hosseini Yazdi M, Totonchi Z, Banar S, Peighambari MM, Hosseini S, Mestres CA. Comparison of six percent hydroxyethyl starch 130/0.4 and ringer's lactate as priming solutions in patients undergoing isolated open heart valve surgery: A double-blind randomized controlled trial. Perfusion 2023:2676591231222135.
14. Gu YJ, Boonstra PW. Selection of priming solutions for cardiopulmonary bypass in adults. Multimed Man Cardiothorac Surg 2006;2006:mmcts.2005.001198.
15. Hosseinzadeh Maleki M, Derakhshan P, Rahmanian Sharifabad A, Amouzeshi A. Comparing the Effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on Renal Function as Priming Solutions for Cardiopulmonary Bypass: A Randomized Double Blind Clinical Trial. Anesth Pain Med 2016;6:e30326.
16. Rehm M, Orth V, Scheingraber S, Kreimeier U, Brechtelsbauer H, Finsterer U. Acid-base changes caused by 5% albumin versus 6% hydroxyethyl starch solution in patients undergoing acute normovolemic hemodilution: a randomized prospective study. Anesthesiology 2000;93:1174-1183.
17. Niemi T, Schramko A, Kuitunen A, Kukkonen S, Suojaranta-Ylinen R. Haemodynamics and acid-base equilibrium after cardiac surgery: comparison of rapidly degradable hydroxyethyl starch solutions and albumin. Scand J Surg 2008;97:259-265.
18. Jacob M, Fellahi JL, Chappell D, Kurz A. The impact of hydroxyethyl starches in cardiac surgery: a meta-analysis. Crit Care 2014;18:656.
19. Holloway DS, Summaria L, Sandesara J, Vagher JP, Alexander JC, Caprini JA. Decreased platelet number and function and increased fibrinolysis contribute to postoperative bleeding in cardiopulmonary bypass patients. Thromb Haemost 1988;59:62-67.
20. Dieterich HJ, Weissmüller T, Rosenberger P, Eltzschig HK. Effect of hydroxyethyl starch on vascular leak syndrome and neutrophil accumulation during hypoxia. Crit Care Med 2006;34:1775-1782.
21. Yeh T Jr, Parmar JM, Rebeyka IM, Lofland GK, Allen EL, Dignan RJ, Dyke CM, Wechsler AS. Limiting edema in neonatal cardiopulmonary bypass with narrow-range molecular weight hydroxyethyl starch. J Thorac Cardiovasc Surg 1992;104:659-665.
22. Reiterer C, Kabon B, Zotti O, Obradovic M, Kurz A, Fleischmann E. Effect of goal-directed crystalloid- versus colloid-based fluid strategy on tissue oxygen tension: a randomised controlled trial. Br J Anaesth 2019;123:768-776.
23. Lee MJ, Tannenbaum C, Mao G, Jia Y, Leung S, Yilmaz HO, Ince I, Soltesz E, Duncan AE. Effect of 6% Hydroxyethyl Starch 130/0.4 on Inflammatory Response and Pulmonary Function in Patients Having Cardiac Surgery: A Randomized Clinical Trial. Anesth Analg 2021;133:906-914.
24. Van der Linden P, De Villé A, Hofer A, Heschl M, Gombotz H. Six percent hydroxyethyl starch 130/0.4 (Voluven®) versus 5% human serum albumin for volume replacement therapy during elective open-heart surgery in pediatric patients. Anesthesiology 2013;119:1296-1309.
25. Tiryakioğlu O, Yildiz G, Vural H, Goncu T, Ozyazicioglu A, Yavuz S. Hydroxyethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial). J Cardiothorac Surg 2008;3:45.
26. Wei L, Li D, Sun L. The comparison of albumin and 6% hydroxyethyl starches (130/0.4) in cardiac surgery: a meta-analysis of randomized controlled clinical trials. BMC Surg 2021;21:342.
27. Gurbuz HA, Durukan AB, Salman N, Tavlasoglu M, Durukan E, Ucar Hİ, Yorgancioglu C. Hydroxyethyl starch 6%, 130/0.4 vs. a balanced crystalloid solution in cardiopulmonary bypass priming: a randomized, prospective study. J Cardiothorac Surg 2013;8:71.
28. Xian-Yu CY, Xu JB, Ma YT, Deng NJ, Tao YT, Li HJ, Gao TY, Yang JY, Zhang C. Management of priming fluids in cardiopulmonary bypass for adult cardiac surgery: network meta-analysis. Ann Med 2023;55:2246996.
| Files | ||
| Issue | Vol 19 No 3 (2024): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v19i3.16859 | |
| Keywords | ||
| Coronary artery bypass Albumins Hydroxyethyl starch Interleukin-6 Blood loss | ||
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How to Cite
1.
Hosseini A, Shahzamani M, Hashemabadi A, Andalib A. The Effects of Albumin 20% and Hydroxyethyl Starch 6% on Bleeding and Interleukin-6 Levels as Priming Solutions for Cardiopulmonary Bypass: A Randomized Controlled Trial. J Tehran Heart Cent. 2024;19(3):162-169.
