Repercusión del cebado con coloides y la ultrafiltración sobre el sangrado posoperatorio y la transfusión sanguínea en cirugía cardiaca. Ensayo clínico aleatorizado / Effect of priming solution and ultrafiltration on post-operative bleeding and blood transfusion in cardiac surgery. Randomized controlled trial

Objetivo. Valorar la eficacia del cebado del sistema de circulación extracorpórea con albúmina-manitol asociado a ultrafiltración para reducir el sangrado posoperatorio y las necesidades transfusionales en cirugía cardiaca, así como su repercusión sobre los balances hídricos, los parámetros de coagulación y hematimetría, la reintervención por sangrado y la estancia en UCI y hospitalaria. Material y métodos. Ciento treinta y cuatro pacientes programados en cirugía cardiaca fueron aleatorizados para recibir en el cebado Ringer lactato 1.500 mL (grupo C), o 250 mL de manitol 20%, 150 mL de albúmina 20% y 1.100 mL de Ringer lactato asociado a ultrafiltración (grupo T). Se determinaron el volumen de sangrado, las transfusiones, los balances hídricos, los parámetros de coagulación y la hematimetría hasta las 48 h del posoperatorio. Resultados. Encontramos una reducción en el grupo T del sangrado posoperatorio, 1.165 ± 789 mL frente a 992 ± 662 mL (p = 0,17), y de la transfusión de hematíes, 694 ± 843 mL frente a 413 ± 605 mL (p = 0,03). El balance hídrico intraoperatorio y posoperatorio fue significativamente menos positivo en el grupo T, con un balance global de 2.292 ± 2.152 mL frente a 5.388 ± 2.834 mL (p < 0,001). Hubo valores superiores de hemoglobina y hematocrito intraoperatorio (p < 0,001), al ingreso en UCI (p = 0,001) y a las 6 h (p = 0,05) en el grupo T, e inferiores de INR a las 6 h (p = 0,01) y 24 h (p = 0,02). Las tasas de reintervención y estancia en UCI fueron superiores en el grupo C, pero no significativas. Conclusiones. El cebado del sistema de circulación extracorpórea con manitol, albúmina y Ringer lactato, asociado a ultrafiltración, mejora significativamente los balances hídricos intraoperatorio y posoperatorio y reduce el volumen de transfusión de sangre, con una repercusión no significativa sobre el sangrado posoperatorio, reintervenciones por sangrado y estancia en UCI (AU)

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 6 h (P = .05) in group T, and lower INR at 6 h (P = .01) and 24 h (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 (AU)

[Effect of priming solution and ultrafiltration on post-operative bleeding and blood transfusion in cardiac surgery. Randomized controlled trial]. / Repercusión del cebado con coloides y la ultrafiltración sobre el sangrado posoperatorio y la transfusión sanguínea en cirugía cardiaca. Ensayo clínico aleatorizado.

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 1,500mL in the priming reservoir (group C), or mannitol 20% 250mL, albumin 20% 150mL and Ringer's lactate 1,100mL combined with ultrafiltration (group T). Bleeding volume, transfusions, fluid balance, coagulation, and hematology parameters were determined until 48h in the post-operative period. RESULTS: There was a reduction of postoperative bleeding in group T, 1,165±789mL vs 992±662mL (P=.17), and red blood cell concentrate transfusions, 694±843mL vs 413±605mL (P=.03). Intra-operative and post-operative fluid balance was significantly less positive in group T, with an overall balance of 2,292±2,152mL vs 5,388±2,834mL (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.