For a study, researchers sought to examine whether using 4% albumin solution instead of Ringer acetate as the cardiopulmonary bypass prime solution and the perioperative intravenous volume replacement solution lowered the incidence of significant perioperative and postoperative complications in patients having cardiac surgery.
Patients undergoing on-pump coronary artery bypass grafting, aortic, mitral, or tricuspid valve surgery, ascending aorta surgery without hypothermic circulatory arrest, and/or the maze procedure were randomly assigned to 2 study groups in a randomized, double-blind, single-center clinical trial from 2017 to 2020 at a tertiary university hospital (the last follow-up was April 13, 2020). The patients received either Ringer acetate solution (n=693) or 4% albumin solution (n=693) in a 1:1 ratio as intravenous volume replacement and cardiopulmonary bypass priming throughout surgery and up to 24 hours later. The number of patients who experienced at least 1 serious adverse event, like death, myocardial infarction, acute heart failure, resternotomy, stroke, arrhythmia, hemorrhage, infection, or acute renal damage, acted as the primary outcome.
In the study, 1,386 of the 1,407 patients who were randomly assigned completed it (99%; mean age, 65.4 [SD, 9.9] years; 1,091 males [79%]; and 295 women [21%]). In the albumin group, patients received a median of 2,150 mL (IQR, 1,598-2,700 mL); in the ringer group, a median of 3,298 mL (IQR, 2,669-3,500 mL) of study fluid. About 257 of 693 patients (37.1%) in the albumin group and 234 of 693 patients (33.8%) in the ringer group experienced at least one serious adverse event (relative risk albumin/Ringer, 1.10; 95% CI, 0.95-1.27; P=.20), representing an absolute difference of 3.3 percentage points (95% CI, -1.7 to 8.4). Pulmonary embolus (11 [1.6%] in the albumin group vs. 8 [1.2%] in the Ringer group), postpericardiotomy syndrome (9 [1.3%] in both groups), and pleural effusion in the intensive care unit or hospital readmission were the most frequent major adverse events (7 [1.0%] in the albumin group vs 9 [1.3%] in the Ringer group).
Treatment with 4% albumin solution for priming and perioperative intravenous volume replacement solution in comparison to Ringer acetate did not substantially lower the incidence of severe adverse events during the next 90 days among patients undergoing heart surgery with cardiopulmonary bypass. The data did not support the usage of a 4% albumin solution in the situation.
Reference: jamanetwork.com/journals/jama/article-abstract/2794363
