Perioperative volume replacement in children undergoing cardiac surgery: Albumin versus hydroxyethyl starch 130/0.4

OBJECTIVE:To compare 4% albumin with 6% hydroxyethyl starch (HES) 130/0.4 in terms of perioperative blood loss and intraoperative fluid requirements in children undergoing cardiac surgery. DESIGN:Prospective randomized study. SETTING:Single University Hospital. PATIENTS:Pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. INTERVENTIONS:One hundred nineteen children were randomized to receive up to 50 mL·kg of either 4% albumin (Albn = 59) or 6% HES 130/0.4 (HESn = 60) for intraoperative fluid volume replacement including the cardiopulmonary bypass priming fluid. Ringerʼs lactate was used for further intraoperative volume needs. Monitoring, anesthetic, and surgical techniques were standardized. Packed red blood cells were administered according to a strict transfusion protocol. Intra- and postoperative blood loss were measured and also calculated from childrenʼs estimated blood volume, pre- and postoperative hematocrit, and volume of transfused packed red blood cells. MEASUREMENTS AND MAIN RESULTS:Volume of colloid used intraoperatively was similar in both groups (median [interquartiles]) (Alb50 [45–50] mL·kg; HES50 [37–50] mL·kg). Measured and calculated blood loss were not different between groups, but a higher number of children in the albumin group required allogeneic blood transfusion (78% vs. 57%; difference between proportions0.213; 95% confidence interval0.05–0.38; p = 0.0188). Intraoperative fluid balance was lower in the HES group (Alb 23 [11–39] mL·kg; HES12 [−5–30] mL·kg; p = 0.005). Postoperative outcome was not different between groups. CONCLUSIONS:In children undergoing cardiac surgery, 6% HES 130/0.4 may represent an interesting alternative to 4% albumin for intraoperative fluid volume replacement because of its lower cost.