James A Russell1, Roberta J Navickis, Mahlon M Wilkes. 1. Program of Critical Care Medicine, Department of Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
OBJECTIVES: To determine the effects of pump priming fluid choice on platelets, fluid balance, and clinical outcomes. DESIGN: Meta-analysis of controlled clinical trials. Primary endpoints were platelet counts, colloid oncotic pressure, on-bypass fluid balance, postoperative weight gain, and colloid usage. SETTING: Cardiac surgery with cardiopulmonary bypass. PATIENTS: Adult and pediatric patients undergoing cardiac surgery, including coronary artery bypass grafting, valve procedures, and correction of congenital cardiac anomalies. INTERVENTIONS: Extracorporeal circuit priming with either albumin or crystalloid. MEASUREMENTS AND RESULTS: The meta-analysis included 21 controlled trials with 1,346 total patients. Albumin prime significantly reduced the on-bypass drop in platelet counts. The pooled weighted mean difference in platelet count drop with albumin versus crystalloid prime was -23.8 x 10(9)/L (confidence interval [CI], -42.8 to -4.7 x 10(9)/L). The colloid oncotic pressure decline was also smaller when albumin rather than crystalloid was used for priming, with a pooled weighted mean difference of -3.6 mm Hg (CI, -4.8 to -2.3 mmHg) during bypass and -2.0 mmHg (CI, -2.9 to -1.1 mmHg) after surgery. Albumin prime correspondingly reduced on-bypass positive fluid balance (-584 mL; CI, -819 to -348 mL) and postoperative weight gain (-1.0 kg; CI, -0.6 to -1.3 kg) compared with crystalloid. Postoperative colloid usage was lower with albumin than crystalloid prime (-612 mL; CI, -983 to -241 mL). CONCLUSIONS: Albumin prime better preserves platelet counts than crystalloid. Albumin also favorably influences colloid oncotic pressure, on-bypass positive fluid balance, postoperative weight gain, and colloid usage. The clinical significance of these observations merits further investigation.
OBJECTIVES: To determine the effects of pump priming fluid choice on platelets, fluid balance, and clinical outcomes. DESIGN: Meta-analysis of controlled clinical trials. Primary endpoints were platelet counts, colloid oncotic pressure, on-bypass fluid balance, postoperative weight gain, and colloid usage. SETTING: Cardiac surgery with cardiopulmonary bypass. PATIENTS: Adult and pediatric patients undergoing cardiac surgery, including coronary artery bypass grafting, valve procedures, and correction of congenital cardiac anomalies. INTERVENTIONS: Extracorporeal circuit priming with either albumin or crystalloid. MEASUREMENTS AND RESULTS: The meta-analysis included 21 controlled trials with 1,346 total patients. Albumin prime significantly reduced the on-bypass drop in platelet counts. The pooled weighted mean difference in platelet count drop with albumin versus crystalloid prime was -23.8 x 10(9)/L (confidence interval [CI], -42.8 to -4.7 x 10(9)/L). The colloid oncotic pressure decline was also smaller when albumin rather than crystalloid was used for priming, with a pooled weighted mean difference of -3.6 mm Hg (CI, -4.8 to -2.3 mmHg) during bypass and -2.0 mmHg (CI, -2.9 to -1.1 mmHg) after surgery. Albumin prime correspondingly reduced on-bypass positive fluid balance (-584 mL; CI, -819 to -348 mL) and postoperative weight gain (-1.0 kg; CI, -0.6 to -1.3 kg) compared with crystalloid. Postoperative colloid usage was lower with albumin than crystalloid prime (-612 mL; CI, -983 to -241 mL). CONCLUSIONS: Albumin prime better preserves platelet counts than crystalloid. Albumin also favorably influences colloid oncotic pressure, on-bypass positive fluid balance, postoperative weight gain, and colloid usage. The clinical significance of these observations merits further investigation.
Authors: Konrad Reinhart; Anders Perner; Charles L Sprung; Roman Jaeschke; Frederique Schortgen; A B Johan Groeneveld; Richard Beale; Christiane S Hartog Journal: Intensive Care Med Date: 2012-02-10 Impact factor: 17.440
Authors: Eero Pesonen; Hanna Vlasov; Raili Suojaranta; Seppo Hiippala; Alexey Schramko; Erika Wilkman; Tiina Eränen; Kaapo Arvonen; Maxim Mazanikov; Ulla-Stina Salminen; Mihkel Meinberg; Tommi Vähäsilta; Liisa Petäjä; Peter Raivio; Tatu Juvonen; Ville Pettilä Journal: JAMA Date: 2022-07-19 Impact factor: 157.335