Effect of 4% Albumin Solution vs Ringer Acetate on Major Adverse Events in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Clinical Trial.
E. 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 +15 more
Reads0
Chats0
TLDR
In this paper , the authors compared 4% albumin solution compared with Ringer acetate as cardiopulmonary bypass prime and perioperative intravenous volume replacement solution in patients undergoing cardiac surgery.Abstract:
Importance
In cardiac surgery, albumin solution may maintain hemodynamics better than crystalloids and reduce the decrease in platelet count and excessive fluid balance, but randomized trials are needed to compare the effectiveness of these approaches in reducing surgical complications.
Objective
To assess whether 4% albumin solution compared with Ringer acetate as cardiopulmonary bypass prime and perioperative intravenous volume replacement solution reduces the incidence of major perioperative and postoperative complications in patients undergoing cardiac surgery.
Design, Setting, and Participants
A randomized, double-blind, single-center clinical trial in a tertiary university hospital during 2017-2020 with 90-day follow-up postoperatively involving patients undergoing on-pump coronary artery bypass grafting; aortic, mitral, or tricuspid valve surgery; ascending aorta surgery without hypothermic circulatory arrest; and/or the maze procedure were randomly assigned to 2 study groups (last follow-up was April 13, 2020).
Interventions
The patients received in a 1:1 ratio either 4% albumin solution (n = 693) or Ringer acetate solution (n = 693) as cardiopulmonary bypass priming and intravenous volume replacement intraoperatively and up to 24 hours postoperatively.
Main Outcomes and Measures
The primary outcome was the number of patients with at least 1 major adverse event: death, myocardial injury, acute heart failure, resternotomy, stroke, arrhythmia, bleeding, infection, or acute kidney injury.
Results
Among 1407 patients randomized, 1386 (99%; mean age, 65.4 [SD, 9.9] years; 1091 men [79%]; 295 women [21%]) completed the trial. Patients received a median of 2150 mL (IQR, 1598-2700 mL) of study fluid in the albumin group and 3298 mL (IQR, 2669-3500 mL) in the Ringer group. The number of patients with at least 1 major adverse event was 257 of 693 patients (37.1%) in the albumin group and 234 of 693 patients (33.8%) in the Ringer group (relative risk albumin/Ringer, 1.10; 95% CI, 0.95-1.27; P = .20), an absolute difference of 3.3 percentage points (95% CI, -1.7 to 8.4). The most common serious adverse events were pulmonary embolus (11 [1.6%] in the albumin group vs 8 [1.2%] in the Ringer group), postpericardiotomy syndrome (9 [1.3%] in both groups), and pleural effusion with intensive care unit or hospital readmission (7 [1.0%] in the albumin group vs 9 [1.3%] in the Ringer group).
Conclusions and Relevance
Among patients undergoing cardiac surgery with cardiopulmonary bypass, treatment with 4% albumin solution for priming and perioperative intravenous volume replacement solution compared with Ringer acetate did not significantly reduce the risk of major adverse events over the following 90 days. These findings do not support the use of 4% albumin solution in this setting.
Trial Registration
ClinicalTrials.gov Identifier: NCT02560519.read more
Citations
More filters
Journal ArticleDOI
Year in Review 2022: Noteworthy Literature in Cardiac Anesthesiology
TL;DR: The authors reviewed 389 articles published in 2022 focused on topics related to clinical practice to identify 16 topics that will impact the current and future practice of cardiac anesthesiology, including risk prediction, postoperative outcomes, clinical practice, and technological advances.
Journal ArticleDOI
Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review
TL;DR: In this article , the authors reviewed the pathogenesis, definition and diagnosis, and pharmacological and nonpharmacological prevention strategies of acute kidney injury (AKI) in cardiac surgical patients, including maintenance of renal perfusion, individualized blood pressure targets, balanced fluid management, goal-directed oxygen delivery and avoidance of nephrotoxins.
Journal ArticleDOI
Albumin vs Crystalloid Fluid for Resuscitation in Cardiac Surgery: New Evidence and Arguments in the Timeless Debate.
Journal ArticleDOI
Why Do the Mechanistic Actions of Albumin Not Translate Into Tangible Clinical Benefits?
TL;DR: Four postulated explanations are provided as to why the theoretical advantages ofalbumin are not apparent in clinical trials: diminished oncotic action due to leakage of albumin from the intravascular compartment, modification of the pleiotropic properties of albumins both in vitro and in vivo, the ability of other plasma proteins to take over the major functions of albumIn, and possible adverse effects.
Journal ArticleDOI
Priming of Cardiopulmonary Bypass with Human Albumin Decreases Endothelial Dysfunction after Pulmonary Ischemia–Reperfusion in an Animal Model
Jean Selim,Mouad Hamzaoui,Antoine Ghemired,Zoubir Djerada,Laurence Chevalier,Nicolas Piton,Emmanuel Besnier,Thomas Clavier,Anaïs Dumesnil,Sylvanie Renet,Paul Mulder,Fabien Doguet,Fabienne Tamion,Benoit Veber,Jeremy Bellien,Vincent Richard,Jean-Marc Baste +16 more
TL;DR: Using HA as a prime in CPB during Ltx could decrease pulmonary endothelial dysfunction’s IR-mediated effects and thus prevent the development of pulmonary graft dysfunction.
References
More filters
Journal ArticleDOI
Sphingosine-1-phosphate protects endothelial glycocalyx by inhibiting syndecan-1 shedding
TL;DR: S1P plays a critical role in protecting the glycocalyx via S1P1 and inhibits the protease activity-dependent shedding of CS, HS, and the syndecan-1 ectodomain.
Journal ArticleDOI
Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery
Joanne Verheij,Arthur van Lingen,Albertus Beishuizen,Herman M.T. Christiaans,Jan R de Jong,Armand R. J. Girbes,Willem Wisselink,Jan A. Rauwerda,Marinus A J M Huybregts,A. B. Johan Groeneveld +9 more
TL;DR: Colloid fluid loading leads to a greater increase in preload-recruitable cardiac and left ventricular stroke work indices than that with saline, because of greater plasma volume expansion following an increase in plasma COP.
Journal ArticleDOI
Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer's lactate on blood loss and coagulation after cardiac surgery
Keso Skhirtladze,Eva Base,Andrea Lassnigg,A. Kaider,S. Linke,Martin Dworschak,Michael Hiesmayr +6 more
TL;DR: Despite equal blood loss from chest drains, both colloids interfered with blood coagulation and produced greater haemodilution, which was associated with more transfusion of blood products compared with crystalloid use only.
Journal ArticleDOI
Effect of Exogenous Albumin on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Off-pump Coronary Artery Bypass Surgery with a Preoperative Albumin Level of Less Than 4.0 g/dl
Eun-Ho Lee,Wook-Jong Kim,Ji-Yeon Kim,Ji-Hyun Chin,Dae-Kee Choi,Ji-Yeon Sim,Suk-Jung Choo,Cheol-Hyun Chung,Jae Won Lee,In-Cheol Choi +9 more
TL;DR: Administration of 20% exogenous albumin immediately before surgery increases urine output during surgery and reduces the risk of AKI after off-pump coronary artery bypass surgery in patients with a preoperative serum albumin level of less than 4.0 g/dl.
Journal ArticleDOI
Albumin augmentation improves condition of guinea pig hearts after 4 hr of cold ischemia.
Matthias Jacob,Oliver Paul,Laurenz Mehringer,Daniel Chappell,Markus Rehm,Ulrich Welsch,Ingo Kaczmarek,Peter Conzen,Bernhard F. Becker +8 more
TL;DR: Augmenting HTK with human albumin improves endothelial integrity and heart performance after 4 hr cold ischemia, because of a marked protection of the endothelial glycocalyx.