HEMOSTATIC EFFECTS OF 3 COLLOID PLASMA SUBSTITUTES FOR PRIMING SOLUTION IN CARDIOPULMONARY BYPASS

Objective: To evaluate the effects on hemostasis of three different pl asma substitutes with special reference to a newly developed hydroxyet hyl starch used as priming solution in an extracorporeal circuit as we ll as peri- and postoperative infusion fluid, we studied 36 patients r andomly assigned to one of three groups, undergoing coronary artery by pass grafting. Methods: The compositions of the priming solutions were : 2.5% hydroxyethyl starch; 3% gelatin; and 4% human albumin. Platelet function tests and clotting assays were performed on blood samples co llected during and after cardiopulmonary bypass. Results: We found tha t plasma von Willebrand Factor remained higher in the human albumin gr oup. Hydroxyethyl starch preserved platelet agglutination as well as h uman albumin, whereas platelet aggregation induced by adenosine 5'-di phosphate (ADP) proved to be similarly affected during cardiopulmonary bypass in thr three study groups. Prolongation of the in vitro bleedi ng constant during the bypass period and subsequent partial recovery s howed an affected platelet function in all groups during cardiopulmona ry bypass. The dotting times, activated partial thromboplastin time an d prothrombin time were similar in the three groups. Bloodless, peri- and postoperatively, showed also no differences. Hydroxyethyl starch a ppeared most cost-effective as priming solution in an extracorporeal c ircuit. Conclusions: We conclude that, with human albumin the golden s tandard, 2.5% hydroxyethyl starch is a suitable colloid plasma substit ute to be used as priming solution in an extracorporeal circuit as wel l as peri- and postoperative infusion fluid, reasonably well maintaini ng hemostasis. (C) 1997 Elsevier Science B.V.