Synthetic Colloids in Cardiac Surgery: What Are the Indications?

The early circuits for cardiopulmonary bypass (CPB) required fairy large priming volumes, typically around 2.5 L. Once the benefits of hemodilution were recognized in the 1960s, crystalloids replaced blood as the main component of priming solutions. With this advance, however, came the realization of myocardial edema and its associated sequelae. Edema formation was also a problem in trauma patients, and at about the same time there was interest in decreasing the amount of crystalloid administered during large-volume resuscitations. Colloids held the potential to restore plasma volume more rapidly and more efficiently with less fluid accumulation in the lungs and interstitial space. These observations have guided the ensuing search for the ideal fluid for CPB priming, as well as for volume resuscitation commonly required in cardiac surgical patients (Supplemental Digital Content 1, http:// links.lww.com/ASA/A431).