P151 High-dose hydroxyethyl starch 130/0.4 versus recommended-dose hydroxyethyl starch 200/0.5 in CABG surgery: impact on blood loss and transfusions.
1P.Tossios, 2S.-M.Kasper, 2Ph.Meinert, 1M.Südkamp, 2Chr.Diefenbach, 1E.de Vivie, 1U.Mehlhorn
1Department of Cardiothoracic Surgery, University of Cologne, Cologne; 2Department of Anesthesiology, University of Cologne, Cologne.

Objective: Volume replacement using hydroxyethyl starch (HES) 130/0.4 impairs blood coagulation less than with other HES solutions such as HES 200/0.5. We hypothesized that HES 130/0.4 may be used at higher doses without increasing the risk of perioperative bleeding and transfusion requirements.

Methods: We randomized 120 patients scheduled for elective coronary artery bypass surgery to receive either up to 50 ml/kg of 6% HES 130/0.4 or up to 33 ml/kg of 6% HES 200/0.5 for volume replacement during surgery and until 24 h thereafter. The first 33 ml/kg of HES in both groups were administered in a double blind fashion. Volume requirements in excess of the respective maximum dose of HES were covered with gelatin. Colloid use was at the discretion of the attending physicians and not dictated by protocol.

Results: The median volumes of HES administered were 49 ml/kg and 33 ml/kg in the HES 130/0.4 and HES 200/0.5 groups, respectively (p<0.001). Consequently, patients in the HES 130/0.4 group required less gelatin in addition to HES than those in the HES 200/0.5 group (7 vs 20 ml/kg [medians]; p<0.001). The combined volumes of HES and gelatin were similar for both groups (p=0.21). The 24-h chest tube drainage (660 ml vs 705 ml [medians], p=0.60) as well as erythrocyte transfusions (1 unit vs 1 unit [medians]; p=0.45) were similar for both groups. Ten HES 130/0.4 patients and 19 HES 200/0.5 patients received a median of 2 FFP units (p=0.054).

Conclusions: High-dose 6% HES 130/0.4 at a median dose of 49 ml/kg did neither increase blood loss nor transfusions compared with 6% HES 200/0.5 at the manufacturers recommended dose of 33 ml/kg.