I would like to conduct a survey among cardiac anesthesiologists and perfusionists about the composition of prime solutions. I would greatly appreciate if anyone could answer my questions indicating their suggestions.
For years controversy has raged over the inclusion of colloids in pump primes, with specific emphasis placed on the value of albumin as a routine prime constituent. The adjunct of albumin has the rationale to counteract hypotonicity due to excessive hemodilution that could lead to tissue edema and altered organ function.
Hyponcotic primes could promote tissue edema through interstitial expansion with plasma water. In our institution, as in many centers around the world, albumin has been added for years to CPB prime with the aim to offset these changes, although the benefits associated with this practice is still controversial.
When low-molecular-weight hydroxyethyl starch (HES), came into the market, they have been used as volume-expanding adjuncts to crystalloid primes. As an alternative approach to Albumin. In our institution HES 130/0,4 has been largely used in the last decade for prime solutions.
Recently the safety of HES has been greatly questioned till that the FDA and the European drug agency gave a warning on their use in some categories of critical patients and also in cardiac surgery. As result the italian agency has retired HES solution from the market.
What do you think about this issue. Should we definitely use crystalloid-only primes? Is there a reason to come back to albumin?
There has been a lot of debate regarding priming solutions and outcomes.
To my knowledge there is no single prime solution that may fits all clinician.
In adults, we have used ringer solution and mannitol. 2lts as a whole. Good results in thousands of patients.
Negative fluid balance is probably more important wether you use colloids or cristaloids.
In children, that is quite different, and as stated before it depends on many other factors
We did not see any difference in clinical end points between colloid or pure crystalloid prime in adult. The only difference is the price.
In adult cases crystalloid priming - Ringer solution, mannitol and normal saline - total volume 1000 ml with heparin 5000 IU added for more than 10 years without any problems.
In adult cases ringer lactat - ringer solution and mannitol 100 ml and 5000 iu heparine and tranexamic acid 30 mg/kg bolus.
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