Hydroxyethyl starch 130/0.4 versus modified succinylated gelatin for volume expansion in pediatric cardiac surgery patients: the effects on perioperative bleeding and transfusion needs

SUMMARY Volume therapy and maintenance of stable hemodynamics is crucial in children undergoing cardiac surgery on cardiopulmonary bypass (CPB). The clinical use of hydroxyethyl starch (HES) 130/0.4 is limited by the possibility of adverse hemostatic effects which could potentially increase the risk of perioperative bleeding and transfusion requirements. We conducted this study to evaluate the safety and efficacy of HES in comparison with modified succinylated gelatin (MSG). Forty-nine children were randomly assigned to receive either HES (n = 28) or MSG (n = 21) during the pre-bypass period. Coagulation was assessed with thromboelastography (TEG) and the transfusion requirements up to the first postoperative day were documented. Both groups were comparable with respect to age, weight, CPB duration as well as hematological and biochemical laboratory investigations. TEG parameters were not deranged up to the first postoperative period in either group and there was a trend of reduced blood loss and transfusion requirements in HES groups although there was no statistically significant difference. Our study shows that HES 130/0.4 is safe and effective for volume replacement in pediatric cardiac surgery patients.