Pentastarch versus albumin in cardiopulmonary bypass prime: Impact on blood loss

Background: Albumin is commonly used as a volume expander in cardiopulmonar y bypass (CPB) prime. Pentastarch, a low molecular weight hetastarch, may p rovide similar efficacy at decreased cost but is known to alter coagulation profiles. Infectious concerns forced the temporary withdrawal of albumin i n our institution. Therefore we evaluated pentastarch as an alternative wit h regards to perioperative hemostasis and blood loss. Methods: One hundred consecutive adult patients undergoing first-time aorto-coronary bypass were given 750 mL of 10% pentastarch (represented as P in calculations) diluted in 1000 mL of Ringer's solution added in their CPB prime. A similar contro l group of 100 consecutive patients had received 200 mL of 25% albumin (rep resented as A in calculations) diluted in 1500 mL of Ringer's solution. Res ults: Postoperative prothrombin time (PT) was slightly higher with pentasta rch (P: 14.9 +/- 1.5 seconds, A: 14.2 +/- 1.3 seconds, p = 0.003). Postoper ative bleeding was also increased (P: 2337 +/- 1242 mL, A: 1981 +/- 1121 mL , p = 0.034), mostly because of recirculated shed mediastinal blood (P: 834 +/- 499 mL, A: 640 +/- 388, p = 0.002) rather than lost pleural tube blood (P: 1503 +/- 821 mL, A: 1341 +/- 824 mL, p = 0.16). Overall net blood loss (P: 2014 +/- 914 mL, A: 2061 +/- 1015, p = 0.73) was similar. Blood-produc t transfusion requirements and postoperative daily hematocrits did not diff er. Conclusion: The diminished coagulability associated with this dose of p entastarch resulted in increased postoperative bleeding. However, with reci rculation of shed mediastinal blood, there was no net increase in blood los s. In this setting, pentastarch may serve as a suitable alternative to albu min.