Albumin, which is a 65-kDa liver-synthesized protein, accounts for nearly 50% of total plasma protein and contributes to approximately 80% of intravascular oncotic pressure. Albumin helps maintain microvascular integrity, functions as an antioxidant, and transports hormones, fatty acid, bile salts, bilirubin, electrolytes (e.g., calcium, magnesium, copper, zinc, et al.), and drugs.^[1–3] Human serum albumin (HSA) is a sterile, liquid albumin product derived from large pools of human plasma by fractionation and pasteurization. The medical use of HAS could date back to approximately the time of World War II.^[4] Cardiac surgery inevitably causes major changes, such as surgical trauma, blood loss, hemodilution, and a systemic inflammatory response, in patients.^[5–7] HSA has been widely used in adult patients undergoing cardiac surgery for fluid resuscitation, pump priming, or correction of hypoalbuminemia, etc.^[8,9] However, evidence and practice guidelines are still lacking regarding the use of HSA in cardiac surgical patients. There is notable interhospital variation in terms of how HSA is used. Inappropriate clinical use of HSA is not uncommon, which may cause enormous waste, and increase the burden of healthcare.^[3]

Our goal was to develop an expert consensus on the use of HSA in adult patients who underwent cardiac surgery. We aimed to help understand the roles of HSA infusion in perioperative treatment and improve patients’ care by systemically evaluating available evidence in the literature. This consensus was written collaboratively by a multidisciplinary team consisting of cardiac surgeons, anesthesiologists, intensivists, perfusionists, and other healthcare providers who care for cardiac surgical patients.