The Effect of Intraoperative 6% Balanced Hydroxyethyl Starch (130/0.4) During Cardiac Surgery on Transfusion Requirements

ObjectivesTo compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative fluid therapy.DesignData were obtained retrospectively from medical records and perfusion charts. Matching based on propensity scores was used to adjust for potential confounders.SettingA university hospital.ParticipantsAdult patients undergoing cardiac surgery with the use of cardiopulmonary bypass.InterventionsAllocation to one of the study groups according to whether balanced HES or balanced crystalloids was used for pump prime and intraoperative fluid therapy.Measurements and Main Results240 propensity-matched patients were retained for final analyses. Forty-eight patients (40%) of the colloid group and 28 patients (23.3%) of the crystalloid group received blood products, with an odd ratio (95% CI) of 2.1(1.2-3.8 (P = 0.009). After bypass HES patients had lower hemoglobin levels (8.4 [1.3] gr/dL vs 9.6 [2] gr/dL; P<0.001) and a higher cumulative chest drain output after 3 hours (180 [210] mL vs 140 [100] mL, P<0.001]. Heparinase thromboelastogram (TEG®) showed longer K times (2.5[1.1] vs 1.6[0.8], P<0.001) and lower maximal amplitudes (55.1[12.5] vs 63.4[9.8], P = 0.008).ConclusionsHES patients required more transfusions, owing to greater hemodilution, HES-induced clotting disturbances, and bleeding.