Abstract

OBJECTIVE To determine the effect of normovolaemic haemodilution in patients after a cerebrovascular accident. DESIGN Prospective, randomized clinical trial. SETTING St Lucas Hospital, Amsterdam. METHOD Normovolaemic haemodilution was achieved by means of bloodletting and administration of a 20% solution of albumin plus crystalline infusion fluids under haemodynamic and rheological monitoring during the acute phase of the cerebral infarction. All patients were subjected to general intensive care and monitoring with a pulmonary artery catheter. This custom-tailored fluid therapy was guided by a pulmonary wedge pressure of 12 mm Hg (SD 3) and a haematocrit (Ht) of 0.32 l/l (SD 0.02). The control group only received individually dosed rehydration with crystalline infusion fluids. Endpoints of the study after 3 months were mortality and dependence/independence concerning everyday functioning. RESULTS The results in the total haemodilution group and the control group did not differ significantly. However, in the subgroup with normal Ht (< 0.45 l/l; n = 201) there was a significant reduction (p < 0.05) of the mortality after 3 months (27% and 16%, respectively) and an increase of independence at home (35% and 48%, respectively) due to a reduction of the viscosity by means of haemodilution with albumin (a specific viscosity effect in the normovolaemic group). In the control group with raised Ht (dehydration; Ht > or = 0.45 l/l; n = 50) there was a significant decrease (p < 0.005) of the mortality after 3 months (27% and 8%, respectively) and an increase of independence at home (35% and 59%, respectively) compared with the control group with normal Ht without signs of dehydration (Ht < 0.045 l/l; n = 102), due to rehydration exclusively with crystalline infusion fluids (a specific rehydration effect in the dehydrated group). CONCLUSION In cerebrovascular accident patients haemodilution should be adjusted individually; in normovolaemic patients haemodilution should be carried out with an albumin solution; the higher the Ht, the more rehydration with crystalline infusion fluids is to be carried out.

Abstract

The Amsterdam Stroke Study was a prospective, single-center, randomized clinical trial, investigating the effect of normovolemic hemodilution and rehydration with albumin 20% and crystalloids. All patients (n = 300) received general intensive care treatment and monitoring with a pulmonary artery catheter. The therapy was individually "customized" and guided on the pulmonary capillary wedge pressure of 12 +/- 3 mm Hg and for the hemodilution group on a hematocrit of 0.32 +/- 0.02 l/l. The significant differences in the subgroups emphasize the importance of a differentiation between a viscosity effect and an effect in hemodilution therapy, sometimes intensifying, sometimes counteracting each other.