Hemostatic effects of three colloid plasma substitutes for priming solution in cardiopulmonary bypass

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Abstract
OBJECTIVE: To evaluate the effects on hemostasis of three differentplasma substitutes with special reference to a newly developed hydroxyethylstarch used as priming solution in an extracorporeal circuit as well asperi- and postoperative infusion fluid, we studied 36 patients randomlyassigned to one of three groups, undergoing coronary artery bypassgrafting. METHODS: The compositions of the priming solutions were: 2.5%hydroxyethyl starch; 3% gelatin; and 4% human albumin. Platelet functiontests and clotting assays were performed on blood samples collected duringand after cardiopulmonary bypass. RESULTS: We found that plasma vonWillebrand Factor remained higher in the human albumin group. Hydroxyethylstarch preserved platelet agglutination as well as human albumin, whereasplatelet aggregation induced by adenosine 5'-di phosphate (ADP) proved tobe similarly affected during cardiopulmonary bypass in the three studygroups. Prolongation of the in vitro bleeding constant during the bypassperiod and subsequent partial recovery showed an affected platelet functionin all groups during cardiopulmonary bypass. The clotting times, activatedpartial thromboplastin time and prothrombin time were similar in the threegroups. Blood loss, peri- and postoperatively, showed also no differences.Hydroxyethyl starch appeared most cost-effective as priming solution in anextracorporeal circuit. CONCLUSIONS: We conclude that, with human albuminthe golden standard, 2.5% hydroxyethyl starch is a suitable colloid plasmasubstitute to be used as priming solution in an extracorporeal circuit aswell as peri- and postoperative infusion fluid, reasonably well maintaininghemostasis.