Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American Medical Association, 328(3), 251–258. https://doi.org/10.1001/jama.2022.10461 Dr. Eero Pesonen et al
Points
- The goal of this trial study was to compare 4% albumin with Ringer acetate for its effectiveness and safety when used as a priming solution during cardiopulmonary bypass and volume replacement for intraoperative and postoperative patients who undergo on-pump cardiac surgery.
- The result of the albumin trial showed that there is no significant reduction in the adverse event over the period of 90 days when 4%albumin is used in spite of the Ringer acetate for priming and pre-operative intravenous volume replacement among patients of on-pump cardiac surgery.
- The other important finding is that patients receiving albumin have a low risk of getting myocardial injury but, on the other hand, have a high risk of bleeding, infection, and reoperation.
- The overall rate of mortality was the same among both strategies.
Summary
An albumin trial was conducted to check the benefits of Albumin 4% during on-pump cardiac surgery instead of Ringer acetate as a priming solution during cardiopulmonary bypass and volume replacement for intraoperative and postoperative patients who undergo on-pump cardiac surgery. For this purpose, 1407 patients in the age range 18-90 years who were going through cardiac surgery were selected from Helsinki University Hospital, Helsinki, Finland.
Patients having primary or repeat open heart surgery procedures independently or in combination with aortic, mitral, or tricuspid valve replacement or repair; coronary artery bypass graft surgery; ascending aorta or aortic root surgery without hypothermic circulatory arrest, or the maze procedure was included. Patients having immediate emergency surgery, congenital cardiac surgery or infection compromised to post-procedural rehabilitation, recurrent heart failure or low output syndrome, end-stage kidney disease, hemophilia A or B, or patient refusal of blood derivatives or products were not included in the study.
The study was double-blind and comprised of two groups: albumin 4% (693) and Ringer acetate (693). The study solution was used for priming, then during surgery, and then in ICU until discharge for volume replacement. The result of the trial indicated that there is no significant reduction in the adverse event over the period of 90 days when 4%albumin is used in spite of the Ringer acetate for priming and pre-operative intravenous volume replacement among patients of on-pump cardiac surgery. The other important finding is that patients receiving albumin have a low risk of getting myocardial injury but, on the other hand, have a high risk of bleeding, infection, and reoperation. The overall rate of mortality was the same among both strategies.
Link to the article: https://jamanetwork.com/journals/jama/article-abstract/2794363
References Pesonen, E., Vlasov, H., Suojaranta, R., Hiippala, S., Schramko, A., Wilkman, E., Eränen, T., Arvonen, K., Mazanikov, M., Salminen, U.-S., Meinberg, M., Vähäsilta, T., Petäjä, L., Raivio, P., Juvonen, T., & Pettilä, V. (2022). Effect of 4% albumin solution vs ringer acetate on major adverse events in patients undergoing cardiac surgery with cardiopulmonary bypass: A randomized clinical trial. JAMA, 328(3), 251–258. https://doi.org/10.1001/jama.2022.10461 Podgoreanu, M. V., & Mamoun, N. (2022). Albumin vs crystalloid fluid for resuscitation in cardiac surgery: New evidence and arguments in the timeless debate. JAMA, 328(3), 246–248. https://doi.org/10.1001/jama.2022.10113
