Impact of balanced tetrastarch raw material on perioperative blood loss: a randomized double blind controlled trial. (17th October 2016)

• Record Type: Journal Article
• Authors: Joosten, A.; Tircoveanu, R.; Arend, S.; Wauthy, P.; Gottignies, P.; Van der Linden, P.
• Editors: Hemmings, H. C.
• Is Part Of: British journal of anaesthesia. Volume 117:Number 4(2016:Oct.)
• Page Start: 442
• Page End: 449
• Publication Date: 2016-10-17
• Subjects: acute kidney injury -- blood loss -- cardiac surgical procedures -- colloids -- hydroxyethyl starch; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1093/bja/aew249
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract : Background: As 6% hydroxyethyl starch (HES) 130/0.40 or 130/0.42 can originate from different vegetable sources, they might have different clinical effects. The purpose of this prospective, randomized, double-blind controlled trial was to compare two balanced tetrastarch solutions, one maize-derived and one potato-derived, on perioperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: We randomly assigned 118 patients undergoing elective cardiac surgery into two groups, to receive either a maize- or a potato-derived HES solution. Study fluids were administered perioperatively (including priming of CPB) until the second postoperative day (POD#2) using a goal directed algorithm. The primary outcome was calculated postoperative blood loss up to POD#2. Secondary outcomes included short-term incidence of acute kidney injury (AKI), and long-term effect (up to one yr) on renal function. Results: Preoperative and intraoperative characteristics of the subjects were similar between groups. Similar volumes of HES were administered (1950 ml [1250–2325] for maize-HES and 2000 ml [1500–2700] for potato-HES; P =0.204). Calculated blood loss (504 ml [413–672] for maize-HES vs 530 ml [468–705] for potato-HES; P =0.107) and the need for blood components were not different between groups. The incidence of AKI was similar in both groups ( P =0.111). Plasma creatinine concentration and glomerular filtration rates did vary over time, although changes were minimal. Conclusions: Under our study conditions, HES 130/0.4 or 130/0.42 raw material did not have a significant influence on perioperative blood loss. Moreover, we did not find any effect of tetrastarch raw material composition on short and long-term renal function. Clinical trial registration: EudraCT number: 2011-005920-16.