COMPARISON OF HETASTARCH WITH ALBUMIN FOR POSTOPERATIVE VOLUME EXPANSION IN CHILDREN AFTER CARDIOPULMONARY BYPASS

Objective: Hetastarch has been studied as a volume expander in adults after cardiopulmonary bypass (CPB) acid in recommended dosages has not altered coagulation studies or increased clinical bleeding. Hetastarc h was compared with albumin in children after CPB to determine whether hetastarch use was associated with increased clinical bleeding or alt eration of coagulation studies. Design; Randomized double blinded stud y. Setting: University-affiliated children's hospital. Participants: F orty-seven children age 1 year or greater (mean 72.8 months; range 12 months to 15.5 years) scheduled for repair of congenital heart disease with moderate hypothermia were randomized to receive hetastarch or al bumin as a postoperative volume expander during the first 24 hours aft er surgery. Interventions: Thirty-eight children required colloid repl acement therapy. Blood pressure, central venous pressure, urine output , and chest tube drainage were used to determine colloid requirement. Measurements and Main Results: Clinical bleeding and laboratory studie s of coagulation were evaluated as were requirements for colloid, crys talloid, and blood products. Twenty children received 6% hetastarch, a nd 18 received 5% albumin. No differences were found in the amount of replacement fluids required, or in coagulation parameters in children receiving 20 mL/kg or less of either colloid replacement therapy. An i ncrease in prothrombin time was demonstrated in children who received greater than 20 mL/kg of 6% hetastarch (p = 0.006); however, no differ ence in clinical bleeding or blood product requirement was demonstrate d between the hetastarch or albumin groups receiving more than 20 mL/k g.Conclusion: This study demonstrated that 6% hetastarch is safe and a n effective plasma volume expander in the postoperative management of children, using volumes up to 20 mL/kg. Close laboratory monitoring an d careful evaluation of clinical bleeding are suggested when larger do ses of hetastarch are administered because of prolongation of the prot hrombin time with more than 20 mL/kg of hetastarch. Copyright (C) 1996 by W.B. Saunders Company.