High Oncotic Pressure Cardiopulmonary Bypass Priming with Human Albumin Improves Outcomes in Pediatric Open-Heart Surgery

Noting a paucity of literature regarding the association of high- oncotic priming solutions for pediatric cardiopulmonary bypass (CPB) and clinical outcomes, specialists at India’s Sir Ganga Ram Hospital conducted a double-blinded, randomized controlled study to examine the impact of high oncotic pressure priming by the addition of 20 percent human albumin prior to the initiation of CPB.

Consecutive children with congenital heart diseases admitted for open-heart surgery were randomized to the conventional prime group (n = 37) or the high oncotic prime group (n= 39). In the first 24-hour postoperative period, children in the albumin group had a significantly lower occurrence rate of hypotension (28.2 vs. 54 percent, P = 0.02), a lower requirement for fluid boluses (25.6 vs. 54 percent, P = 0.006) and a shorter lactate clearance time (6 vs. 9 hours, P < 0.001). Platelet count was also significantly higher in the albumin group at 24 hours (112 vs. 91 x 103/mL, P = 0.02).

There was no significant difference between groups in intra- CPB hemodynamic parameters or incidence of acute kidney injury. In a risk-stratified subgroup analysis, both a reduced intensive care unit stay (4 days vs. 5 days, P = 0.04) and hospital stay (5 days vs. 7 days, P = 0.002) were documented in the albumin prime group. The investigators concluded high oncotic pressure addition of concentrated albumin to the CPB prime might be beneficial over conventional blood prime, and that further studies are warranted.