Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding

doi:10.1016/S0003-4975(01)02745-X

The Annals of Thoracic Surgery

Volume 72, Issue 2, August 2001, Pages 527-533

https://doi.org/10.1016/S0003-4975(01)02745-X Get rights and content

Abstract

Background. This meta-analysis tested the hypothesis that cumulative blood loss during the first 24 hours after cardiopulmonary bypass is lower in patients exposed to albumin than hydroxyethyl starch (HES).

Methods. Randomized controlled trials comparing albumin and HES in cardiopulmonary bypass patients were identified by bibliographic database searches and other methods.

Results. Sixteen trials involving 653 randomized patients were included. In 88% of randomized comparisons, postoperative bleeding was lower in the albumin group, and the standardized mean difference in bleeding favoring albumin across all trials (−0.24; 95% confidence interval, −0.40 to −0.08) was statistically significant. Bleeding differences between albumin and either high or medium molecular weight HES were similar. In trials of adults, the pooled mean blood loss in the albumin group was 693 ± 350 mL compared with 789 ± 487 mL in the HES group. The estimated proportion of adult albumin group patients with blood loss of more than 1,000 mL was 19% compared with 33% of adult HES group patients.

Conclusions. Postoperative blood loss is significantly lower in cardiopulmonary bypass patients exposed to albumin than HES.

Section snippets

End points

The primary end point for the meta-analysis was cumulative volume of mediastinal blood loss over the first 24 hours after cardiopulmonary bypass. Secondary end points consisted of reoperation caused by bleeding, duration of intubation, and length of intensive care unit stay. Blood product usage was also evaluated.

Trial inclusion criteria

Candidate trials must have involved randomized comparison of exogenous purified albumin with HES in patients undergoing cardiopulmonary bypass. No restrictions were placed on the type

Included trials

Nineteen candidate trials were identified. One prospective trial was excluded, because it was unclear whether patients were randomly allocated to treatment groups [25]. Two trials were excluded either because of absence of postoperative bleeding data [26] or administration of albumin in the form of plasma protein fraction rather than purified albumin [27]. The remaining 16 trials involving a total of 653 randomized patients were included (Table 1). All of the included trials had been published.

Comment

In trials comparing albumin and HES usage there was a statistically significant difference favoring albumin in cumulative mediastinal drainage during the first 24 hours postoperatively. The results of the meta-analysis are consistent with those of the larger-scale observational studies indicating impaired hemostasis, increased postoperative bleeding, and higher transfusion requirements in cardiopulmonary bypass patients receiving HES 1, 2, 3, 4, 5.

The observation of less bleeding in albumin

Acknowledgements

This study was supported by the Plasma Protein Therapeutics Association and the American Red Cross.

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^☆: Doctors Wilkes and Navickis are principals in Hygeia Associates, Grass Valley, California.

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Original article: cardiovascularAlbumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding☆

Abstract

Section snippets

End points

Trial inclusion criteria

Included trials

Comment

Acknowledgements

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Br J Anaesth

J Cardiothorac Vasc Anesth

Lancet

Ann Thorac Surg

Ann Thorac Surg

A cluster of severe postoperative bleeding following open heart surgery

Infect Control Hosp Epidemiol

Intraoperative hetastarch infusion impairs hemostasis after cardiac operations

Ann Thorac Surg

Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery?

Anesth Analg

The epidemiology of hemorrhage related to cardiothoracic operations

Infect Control Hosp Epidemiol

Original article: cardiovascular
Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding☆