Does a balanced colloid decrease perioperative blood loss in paediatric cardiac surgery

European Journal of Anaesthesiology, vol. 38, pp. 923–931

Abstract

BACKGROUND: Unbalanced fluid solutions cause metabolic acidosis and could be associated with impaired coagulation and increased blood loss. OBJECTIVE: To investigate whether the use of a balanced colloid compared with a saline colloid for peri-operative fluid therapy in children undergoing cardiac surgery is associated with decreased blood loss and exposure to blood products. DESIGN: Double-blinded randomised controlled trial. SETTING: Tertiary children's hospital from 2013 to 2016. PATIENTS: Children older than 29 days and younger than 3 years admitted for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria were emergency cardiac surgery, moribund (American Society of Anesthesiologists 5), Jehovah's witnesses, coagulopathy, renal failure, liver injury, intracranial haemorrhage and electrolyte disturbances. From the 128 patients eligible, 88 were included in the study. INTERVENTION: Random assignment of patients to either a saline colloid (6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) or a balanced-electrolyte colloid (6% hydroxyethyl starch 130/0.4 in an isotonic solution) for CPB priming and intra- and postoperative fluid therapy during the first postoperative 48 h. MAIN OUTCOME MEASURE: The primary outcome measure was calculated blood loss until the third postoperative day (POD3). RESULTS: A total of 44 patients were included in each study arm. Calculated blood loss at POD3 was not significantly different between the groups (saline colloid 19.9 [IQR 13.8 to 26.1] ml kg-1 versus balanced colloid 15.9 [IQR 9.0 to 25.3 ml kg-1], P = 0.409). Secondary outcomes related to bleeding, exposure to blood products and coagulation were not different between groups. There was also no difference in length of mechanical ventilation, intensive care and hospital length of stay between groups. CONCLUSION: The use of a balanced colloid for peri-operative fluid therapy compared with a saline one is not associated with decreased blood loss or exposure to blood products. TRIAL REGISTRATION: EudraCT identifier: 2012-006034-17 and ClinicalTrial.gov identifier: NCT02584868.

Authors 5

1. Ariane Willems corresponding Aachen Paediatric Intensive Care Unit Department of Intensive Care Department of Anaesthesiology to Ariane Willems Paediatric Intensive Care Unit Department of Intensive Care

   Leiden University · Leiden University Medical Center · Centre Hospitalier Universitaire Brugmann · Queen Fabiola Children's University Hospital

   Affiliation as printed

   From the Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands (AW), Department of Anaesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS, P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)

   Published online 6 May 2021

   Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.ejanaesthesiology.com)

   e-mail: [email protected]

   the Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands (AW), Department of Anaesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS, P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)

   to Ariane Willems, Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 6333 ZA Leiden, The Netherlands Tel: +31 71 526 16 77

2. F. De Groote Aachen Paediatric Intensive Care Unit Department of Intensive Care Department of Anaesthesiology

   Leiden University · Leiden University Medical Center · Centre Hospitalier Universitaire Brugmann · Queen Fabiola Children's University Hospital

   Affiliation as printed

   Published online 6 May 2021

   Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.ejanaesthesiology.com)

   the Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands (AW), Department of Anaesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS, P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)

3. Denis Schmartz Aachen Paediatric Intensive Care Unit Department of Intensive Care Department of Anaesthesiology

   Leiden University · Leiden University Medical Center · Centre Hospitalier Universitaire Brugmann · Queen Fabiola Children's University Hospital

   Affiliation as printed

   Published online 6 May 2021

   Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.ejanaesthesiology.com)

   the Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands (AW), Department of Anaesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS, P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)

4. Jean‐François Fils Aachen Paediatric Intensive Care Unit Department of Intensive Care Department of Anaesthesiology

   Leiden University · Leiden University Medical Center · Centre Hospitalier Universitaire Brugmann · Queen Fabiola Children's University Hospital

   Affiliation as printed

   Published online 6 May 2021

   Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.ejanaesthesiology.com)

   the Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands (AW), Department of Anaesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS, P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)

5. Philippe Van der Linden Aachen Paediatric Intensive Care Unit Department of Intensive Care Department of Anaesthesiology

   Leiden University · Leiden University Medical Center · Centre Hospitalier Universitaire Brugmann · Queen Fabiola Children's University Hospital

   Affiliation as printed

   Published online 6 May 2021

   Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.ejanaesthesiology.com)

   the Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands (AW), Department of Anaesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS, P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)