To assess the efficacy and safety of albumin as pump priming fluid in cardiac surgery.

Meta-analysis of randomized controlled trials.

Each study was conducted in a surgical center or intensive care unit.

Adult and pediatric patients undergoing cardiac surgery with cardiopulmonary bypass who received circuit priming fluids.

Extracorporeal circuit priming with either albumin or crystalloid.

Fourteen eligible randomized controlled trials with 741 patients were included in the present meta-analysis. Albumin prime had lower bleeding (CI –202.20 to –142.88 mL, p < 0.00001) and showed a greater advantage in preserving platelet counts (CI 14.85-21.48 × 10³ mm⁻³, p < 0.00001), maintaining colloid osmotic pressure and sustaining negative fluid balance. No significant differences were found in the remaining study outcomes.

Albumin was shown to be safe and efficacious in extracorporeal circulation perfusion. However, its clinical advantages were not clearly highlighted, as there were no significant differences in the number of deaths, length of hospital stay, or intensive care unit duration. The results should be interpreted cautiously, as most included studies were small in scale, and the total number of participants was limited.