A comparison of crystalloid versus colloid used as priming solution for cardiopulmonary bypass during open heart surgery in adult patients

The right choice of priming solution is of most importance for the well being of the patients undergoing cardiopulmonary bypass (CPB) surgery. Osmolarity, electrolytes and dilutional effects are three major factors which should be considered by the perfusionist when selecting a solution to prime the CPB circuit.

Thirty patients of either sex in the range of 20–70 years of age undergoing coronary artery bypass grafting (CABG) with the use of CPB were randomly divided into two groups (A & B). In Group A (n=15), a crystalloid prime (Ringer Lactate) was used for priming the CPB circuit. In Group B (n=15), a colloid solution (Voluven 130/0.4) was used along with crystalloid prime (Ringer lactate) in 2:1 ratio as the priming solution for the CPB circuit. All the surgeries were conducted by using same surgical, anesthetic and perfusion techniques. Various parameters compared between the two groups were: Hb/HCT, K⁺/Na⁺, BSA, blood pressure, P O, PCO, saturation %, (PO-P O), urine output, serum creatinine, blood urea, blood sugar, requirement of a hemofiltration, requirement of blood/blood products, and requirement of any other additions.

Hospital mortality was zero in both the groups; however, it was found that Voluven can be used as an alternative along with Ringer lactate in the ratio 2:1 for priming the CPB circuit without any adverse effect. The volume requirement is significantly lower when Voluven is used in priming solution along with Ringer lactate. Voluven may cause nonsignificant inflammatory response and nonsignificant increase in blood urea and serum creatinine and is not associated with any serious adverse effect or renal insufficiency. But caution must be taken while using it in patients in acute or chronic renal failure. (Ind J Extra Corpor Technol 2010;20:19–23)