Comparison of three different colloids solution for pump priming in infant pa-tients undergoing heart surgery

Miao Xiao-lei; Liu Jin-ping; Cui Yong-li; Zhao Ming-xia; Feng Zheng-yi; Zhao Ju; Long Cun; Li Shou-jun; Yan Fu-xia; Wang Xu; Lin Ru; Shu Qiang

doi:10.13498/j.cnki.chin.j.ecc.2014.04.03

Abstract：Objective The aim of this study is to observe the safety and clinical efficiency of three different colloids solution in the circuit priming for infant patients less than 15 kg undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods One hundred and twenty infant patients were randomly divided into 3 groups according to the kind of colloid solutions used in CPB. 6%hydroxyethyl starch 130/0.4 (Voluven), 4%succinylated gelatin (Gelofusine) or fresh frozen plasma were used in CPB circuit prime re?spectively. We used thromboelastography ( TEG) to evaluate the hemostatic function after anesthesia induction and 15 min after protamine administration. The postoperative renal and liver function, blood loss volume, blood products usage and recovery time, including mechani?cal ventilation time, ICU length of stay and hospitalization time, were also compared among the three groups. Results All cases recov?ered smoothly, and without re-open thoracotomy. No patient developed severe renal or liver dysfunction. The colloid osmotic pressure (COP) of the priming solution was higher in Gelofusine or Voluven group than in plasma group (10.2±2.8 vs 9.8±2.7 vs 7.6±2.5, P<0.05). However, the COP measured before or after bypass was comparable among the three groups ( P>0.05). Compared with the preoperative levels, R values from TEG test were all increased while other parameters were all decreased in the three groups after prota?mine administration. After heparin reversal, significantly higher functional fibrinogen levels ( FLEV) and MAf value were shown in plasma group compared with the other two groups ( P<0.01) . There were no differences among the three groups in postoperative clot?ting factor level, platelet function and the final clotting strength. The postoperative bleeding, blood products dosage and recovery time were all at the similar level among the three groups ( P>0.05) . Conclusion Artificial colloids like Voluven and Gelofusine have com?parable effect with plasma in postoperative hemostatic function maintenance. Replacement of plasma with artificial colloids in CPB cir?cuit prime could be safe and effective. We can use TEG to test the postoperative hemostatic function and guide the transfusion protocol after cardiac surgery in infant patients.