Albumin Infusion and Blood Loss after Cardiac Surgery

Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland. Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: eero.pesonen@hus.fi.

The Annals of thoracic surgery. 2023
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Abstract
BACKGROUND In the recent ALBICS trial (ALBumin In Cardiac Surgery), 4% albumin used for cardiopulmonary bypass priming and volume replacement increased perioperative bleeding, compared to Ringer's acetate. In the present exploratory study, albumin-related bleeding was further characterized. METHODS Ringer's acetate and 4% albumin were compared in a randomized, double-blinded fashion in 1386 on-pump adult cardiac surgical patients. The study endpoints for bleeding were the Universal Definition of Perioperative Bleeding (UDPB) class and its components. RESULTS The UDPB bleeding grades were higher in the albumin than the Ringer group: "insignificant" (albumin vs. Ringer: 47.5% vs. 62.9%), "mild" (12.7% vs. 8.9%), "moderate" (28.7% vs. 24.4%), "severe" (10.2% vs. 3.2%), "massive" (0.9% vs. 0.6%), p<0.001. Patients in the albumin group received red blood cells (45.2% vs. 31.5%, p<0.001, odds ratio (OR) 1.80, 95% confidence interval (CI) 1.44-2.24), platelets (33.3% vs.21.8%, p<0.001, OR 1.79, CI 1.41-2.28), and fibrinogen (5.6% vs. 2.6%, p<0.05, OR 2.24: CI 1.27-3.95), and underwent resternotomy (5.3% vs. 1.9%, p<0.001, OR 2.95, CI 1.55-5.60) more often than patients in the Ringer group. The strongest predictors of bleeding were albumin group allocation (OR 2.18, CI 1.74-2.74) and complex- (OR 2.61, CI 2.02-3.37) and urgent surgery (OR 1.63, CI 1.26-2.13). In interaction analysis, the effect of albumin on the risk of bleeding was stronger in patients on preoperative acetylsalicylic acid. CONCLUSIONS Perioperative administration of albumin, compared to Ringer´s acetate, resulted in increased blood loss and higher UDBP class. The magnitude of this effect was similar to the complexity and urgency of the surgery.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine