Does removing Mannitol and Voluven from the priming fluid of the cardiopulmonary bypass circuit have clinical effects?

The Auckland Hospital cardiothoracic unit recently removed Mannitol and Voluven from its Plasma-lyte-based cardiopulmonary bypass (CPB) priming fluid. Like with any change to practice, a comprehensive audit should be performed to identify positive or negative effects. The aim of this retrospective analysis was to investigate the effect of changing the CPB prime constituents on fluid balance and clinical outcome parameters. Clinical records were reviewed for 100 consecutive patients undergoing primary, isolated coronary artery bypass grafting (CABG), 50 patients before the prime change and 50 after. All data were collated into a central database for analysis. Mean arterial pressure while on bypass was higher in the new prime group (61.5 mmHg versus 57.5 mmHg, p = .002). There was no significant difference in hematocrit, hemoglobin, serum sodium, serum potassium, or creatinine postoperatively between groups. In regard to important outcomes such as postoperative weight and fluid balance, time on ventilation, length of stay in the intensive care unit (ICU) or hospital, and mortality, there were no significant differences. Interestingly, new prime group spent a smaller proportion of their time in the ICU on mechanical ventilation (23% versus 36%, p = .022). Mannitol and Voluven, like with all drugs, carry their own potential adverse effects. This study demonstrates that removing Mannitol and Voluven from priming fluid did not have any detrimental effect on electrolytes, fluid status, and other important outcomes in this consecutive series of patients having primary isolated CABG surgery. The risk-benefit balance combined with the obvious economic benefit clearly favors removing Mannitol and Voluven from priming fluids.