Albumin Infusion and Blood Loss After Cardiac Surgery

BACKGROUND In the recent ALBICS (ALBumin In Cardiac Surgery) trial, 4% albumin used for cardiopulmonary bypass priming and volume replacement increased perioperative bleeding compared with Ringer acetate. In the present exploratory study, albumin-related bleeding was further characterized.METHODS Ringer acetate and 4% albumin were compared in a randomized, double-blinded fashion in 1386 on-pump adult cardiac surgery patients. The study end points for bleeding were the Universal Definition of Perioperative Bleeding (UDPB) class and its components.RESULTS The UDPB bleeding grades were higher in the albumin group than the Ringer group: insignificant (albumin vs Ringer: 47.5% vs 62.9%), mild (12.7% vs 8.9%), moderate (28.7% vs 24.4%), severe (10.2% vs 3.2%), and massive (0.9% vs. 0.6%; P < .001). Patients in the albumin group received red blood cells (45.2% vs 31.5%; odds ratio [OR], 1.80; 95% CI, 1.44-2.24; P < .001), platelets (33.3% vs 21.8%; OR, 1.79; 95% CI, 1.41-2.28; P < .001), and fibrinogen (5.6% vs 2.6%; OR, 2.24; 95% CI, 1.27-3.95; P < .05), and underwent resternotomy (5.3% vs 1.9%; OR, 2.95; 95% CI, 1.55-5.60, P < .001) more often than patients in the Ringer group. The strongest predictors of bleeding were albumin group allocation (OR, 2.18; 95% CI, 1.74-2.74) and complex (OR, 2.61; 95% CI, 2.02-3.37) and urgent surgery (OR, 1.63; 95% CI, 1.26-2.13). In interaction analysis, the effect of albumin on the risk of bleeding was stronger in patients on preoperative acetylsalicylic acid.CONCLUSIONS Perioperative administration of albumin, compared with Ringer's acetate, resulted in increased blood loss and higher UDBP class. The magnitude of this effect was similar to the complexity and urgency of the surgery.(Ann Thorac Surg 2023;116:392-400)& COPY; 2023 by The Society of Thoracic Surgeons. Published by Elsevier Inc.

Automated summary

In this study, it was found that perioperative administration of 4% albumin, compared to Ringer's acetate, resulted in increased postoperative bleeding, higher use of blood cells and platelets, and increased probability of resternotomy.