Hetastarch Should be Avoided for Volume Expansion in Cardiac Surgery Patients

Abstract

Blood conservation measures to reduce perioperative blood loss during cardiac surgery have been a subject of focus in recent years. This is due in part to the high cost of allogeneic blood transfusion, as well as the morbidity and mortality associated with transfusion.1 One such conservation measure is hemodilution with colloids such as human albumin (HA) or hydroxyethyl starch (HES). Hemodilution is an inevitable sine qua non condition of cardiopulmonary bypass (CPB) because of its circuit-priming requirements.2 On the other hand, correction of hypovolemia with intravenous (IV) fluids is one of the most frequent therapeutic interventions in cardiac surgery.3 A variety of IV fluids currently are used for volume expansion in major surgery and in critically ill patients.
Crystalloid solutions are inexpensive and widely available,4 while colloids have the theoretical advantage of a lower
plasma clearance, and stronger and sustained colloid osmotic effect so that resuscitation fluid volume and overload consequences may be diminished.4,5 Avoidance of perioperative fluid overload and restrictive blood product utilization have been suggested as means to improve postoperative outcomes.6
Furthermore, it must be remembered that blood transfusion, surgical re-intervention, and perioperative renal dysfunction have been associated with decreased survival after cardiac surgery