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before shifting to the extravascular space . 8 This leads to the repetitive administration of crystalloids , which causes fluid overload . In surgical patients , fluid overload has been demonstrated to be an independent risk factor for morbidity and mortality , and the restriction of intra- and postoperative fluids leads to dramatic outcome improvement . 9
Colloids stay longer ( for up to six hours ) in the intravascular space , and their volume effect is higher then those of crystalloids ( 80 – 300 %). However , the majority of colloid solutions with non-biological origin have been shown to have undesirable side effects . They could impair blood coagulation and renal function , which are already compromised after cardiac surgery .
Albumin is a colloid solution which does not have any clinically significant effect on blood coagulation apart from haemodilution . The volume effect of albumin solution is 80 – 100 % ( in the case of 4 % or 5 % solution ), but for hyperoncotic solutions it rises to up to 300 %. Therefore , using these solutions , it is possible to increase intravascular volume with small
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amounts ( 100 – 200mL ) of fluid . Volume effect of albumin lasts for up to four hours , which is also desirable during and after cardiac surgery .
There are no large randomised controlled trials in cardiac surgery patients comparing albumin to any other fluid . Engelman et al reported that pre-operative hypoalbuminaemia (< 25g / L ) is an independent risk factor for multiple poor outcomes after cardiac surgery . 10 However , Fritz et al in 2003 demonstrated that hypoalbuminemia predicts mortality after cardiac surgery even better than EUROscore . 11 In this study , cut-off for hypoalbuminemia was 18g / L . Several studies investigated the use of albumin for CPB priming . In his retrospective cohort of 19578 patients undergoing CABG procedure , Sedrakyan et al demonstrated that albumin use was associated with reduced mortality ( OR = 0.8 , CI 0.67 – 0.96 ) in comparison to old generation colloids with nonbiological origin . 12 Compared to crystalloids , less volume of priming has been needed in albumin groups . Additionally , the use of albumin solution as prime fluid decreased the amount of
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postoperative bleeding . Onorati et al compared retrospectively the low dose of albumin to pure crystalloid priming in 377 patients . 13 Patients receiving albumin needed smaller amounts of blood transfusions and had lower blood loss postoperatively . Additionally , the rate of resternotomies was significantly less in the albumin group .
Postoperative effects In the postoperative setting , albumin has been compared to different solutions in numerous small prospective studies . In 2006 , Niemi et al demonstrated that the use of both old starch and gelatin solutions correlates with the amount of postoperative bleeding after cardiac surgery , but the use of 4 % albumin solution does not . 14 Schramko et al compared the postoperative infusion in the dose of 15 mL / kg of two starch solutions ( HES200 / 0.5 and HES130 / 0.4 ) to 4 % albumin : albumin did not cause any changes in maximum clot firmness , but both starch solutions decreased this parameter of thromboelastometry slightly , but significantly . 15 After administration of all colloids , cardiac
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