Volume therapy with a new hydroxyethyl starch solution in cardiac surgicalpatients before cardiopulmonary bypass

Objective: To compare the hemodynamic efficacy of a new hydroxyethyl starch (HES) preparation (130/0.4) with an HES 200/0.5 solution. Design: Prospective, randomized, double-blind, phase II study. Setting: An urban, university-affiliate hospital. Participants. Twenty patients undergoing elective first-time cardiac surger y. Interventions: After induction of anesthesia and before the start of surger y, a new HES 130/0.4 (molecular weight, 130,000 d; degree of substitution, 0.4) (n = 10) or HES 200/0.5 (molecular weight, 200,000 d; degree of substi tution, 0.5) (n = 10) was infused (10 mL/kg) within 30 minutes when pulmona ry capillary wedge pressure was less than 10 mmHg. Measurements and Main Results: Extensive hemodynamic monitoring was perform ed 30 and 60 minutes after the end of infusion. Then surgery was started. S tandard laboratory parameters were measured before surgery and on the Ist p ostoperative day. A similar amount of HES was given in both groups (HES 130 , 795 +/- 75 mL; HES 200, 820 +/- 90 mt). Filling pressures (central venous pressure, pulmonary capillary wedge pressure) and cardiac index increased similarly in both groups and remained significantly elevated 60 minutes aft er the end of infusion. Ail other hemodynamic parameters were similar betwe en the two volume groups. Renal (creatinine) and hepatic function (aspartat e aminotransferase, alanine aminotransferase) and hemostasis (platelet coun t, activated partial thromboplastin time, blood toss) were without group di fferences until the morning of the Ist postoperative day. Conclusions: The new 6% HES 130/0.4 was as effective as a 6% HES 200/0.5 pr eparation in regard to hemodynamic efficacy. No negative side effects on or gan function were seen. The 6% HES 130/0.4 solution may become an alternati ve strategy for volume therapy in cardiac surgery. Copyright (C) 2000 by W. B. Saunders Company.