Effect of priming solution and ultrafiltration on post-operative bleeding and blood transfusion in cardiac surgery. Randomized controlled trial

Objective: Assess the effectiveness of priming the extracorporeal circulation system with albumin-mannitol combined with ultrafiltration during extracorporeal circulation to reduce post-operative bleeding and transfusion requirements in heart surgery, as well as its impact on the fluid balance, coagulation and hematocrit parameters, re-operation for bleeding, ICU, and hospital length of stay. Material and methods: A total of 134 patients scheduled for heart surgery were randomized to receive Ringer's lactate 1,500 mL in the priming reservoir (group C), or mannitol 20% 250 mL, albumin 20% 150 mL and Ringer's lactate 1,100 mL combined with ultrafiltration (group T). Bleeding volume, transfusions, fluid balance, coagulation, and hematology parameters were determined until 48 h in the post-operative period. Results: There was a reduction of postoperative bleeding in group T, 1,165 +/- 789 mL vs 992 +/- 662 mL (P = .17), and red blood cell concentrate transfusions, 694 +/- 843 mL vs 413 +/- 605 mL (P = .03). Intra-operative and post-operative fluid balance was significantly less positive in group T, with an overall balance of 2,292 +/- 2,152 mL vs 5,388 +/- 2,834 mL (P < .001). There were higher values of hemoglobin and hematocrit, intraoperative (P < .001), on admission to ICU (P = .001), and at 6h (P = .05) in group T, and lower INR at 6h (P = .01) and 24h (P = .02). Re-operation rate and length of stay in ICU were higher in group C, but not statiscally significant. Conclusions: The priming of extracorporeal reservoir with mannitol, albumin, and Ringer's Lactate, combined with ultrafiltration, significantly improves intra- and post-operative fluid balance, resulting in a reduction in blood transfusions, with no significant decrease in post-operative bleeding, re-operation bleeding rate, and length of stay in the ICU. (C) 2014 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.