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Human albumin: cardiac surgery

"When the use of albumin solution was compared to other colloids with non- biological origin or to crystalloids, the platelet count in the albumin group were significantly higher postoperatively then in the other fluids group"

This leads to the repetitive administration of crystalloids, which causes fluid overload. In surgical patients, fluid overload has been demonstrated to be an independent risk factor for morbidity and mortality, and the restriction of intra- and postoperative fluids leads to dramatic outcome improvement.9

before shifting to the extravascular space.8

Colloids stay longer (for up to six hours) in the intravascular space, and their volume effect is higher then those of crystalloids (80–300%). However, the majority of colloid solutions with non-biological origin have been shown to have undesirable side effects. They could impair blood coagulation and renal function, which are already compromised after cardiac surgery.

Albumin is a colloid solution which does not have any clinically significant effect on blood coagulation apart from haemodilution. The volume effect of albumin solution is 80–100% (in the case of 4% or 5% solution), but for hyperoncotic solutions it rises to up to 300%. Therefore, using these solutions, it is possible to increase intravascular volume with small

amounts (100–200mL) of fluid. Volume effect of albumin lasts for up to four hours, which is also desirable during and after cardiac surgery.

There are no large randomised controlled trials in cardiac surgery patients comparing albumin to any other fluid. Engelman et al reported that pre-operative hypoalbuminaemia (<25g/L) is an independent risk factor for multiple poor outcomes after cardiac surgery.10

However, Fritz et al in 2003 demonstrated that hypoalbuminemia predicts mortality after cardiac surgery even better than EUROscore.11

In this

study, cut-off for hypoalbuminemia was 18g/L. Several studies investigated the use of albumin for CPB priming. In his retrospective cohort of 19578 patients undergoing CABG procedure, Sedrakyan et al demonstrated that albumin use was associated with reduced mortality (OR=0.8, CI 0.67 – 0.96) in comparison to old generation colloids with non- biological origin.12

Compared to

crystalloids, less volume of priming has been needed in albumin groups. Additionally, the use of albumin solution as prime fluid decreased the amount of

postoperative bleeding.Onorati et al compared retrospectively the low dose of albumin to pure crystalloid priming in 377 patients.13

needed smaller amounts of blood transfusions and had lower blood loss postoperatively. Additionally, the rate of resternotomies was significantly less in the albumin group.

Postoperative effects

In the postoperative setting, albumin has been compared to different solutions in numerous small prospective studies. In 2006, Niemi et al demonstrated that the use of both old starch and gelatin solutions correlates with the amount of postoperative bleeding after cardiac surgery, but the use of 4% albumin solution does not.14

Schramko et al

compared the postoperative infusion in the dose of 15 mL/kg of two starch solutions (HES200/0.5 and HES130/0.4) to 4% albumin: albumin did not cause any changes in maximum clot firmness, but both starch solutions decreased this parameter of thromboelastometry slightly, but significantly.15

After administration of all colloids, cardiac 19 Patients receiving albumin

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