Effects of intravascular volume therapy using hydroxyethyl starch (130/0.4) on post-operative bleeding and transfusion requirements in children undergoing cardiac surgery: a randomized clinical trial

Background: Hydroxyethyl starch (HES) used for intravascular volume expansion may cause coagulation abnormalities, especially in cardiac patients. Although low molecular weight HES (130/0.4) has been developed to minimize its influence on coagulation, experience with HES (130/0.4) in children is limited. Therefore, we evaluated the effects of a HES (130/0.4) infusion on postoperative blood loss in children undergoing cardiac surgery. Methods: Forty-two children undergoing cardiac surgery were assigned at random to receive either 10 ml/kg fresh frozen plasma (FFP group; n = 21) or HES (130/0.4) (HES group; n = 21) shortly after cardiopulmonary bypass termination. Activated partial thromboplastin time (aPTT) and international normalization ratio (INR) were measured. In addition, postoperative transfusion requirements and blood loss until the end of the first post-operative day were compared. Results: INR was significantly prolonged after HES infusion in comparison to the FFP group (P < 0.05). During the first 24 h after surgery, post-operative blood loss, the use of allogenic blood/blood products and aPTT were similar in all children. Conclusions: Our study shows that the administration of a moderate dose of HES (130/0.4) in children undergoing cardiac surgery does not cause more bleeding or a higher transfusion requirement than a FFP infusion, and suggests that the administration of 10 ml/kg HES (130/0.4) is a safe alternative to plasma for intravascular volume replacement in this patient population.