Effects of intravascular volume therapy using hydroxyethyl starch (130/0.4) on post-operative bleeding and transfusion requirements in children undergoing cardiac surgery: A randomized clinical trial

Background: Hydroxyethyl starch (HES) used for intravascular volume expansion may cause coagulation abnormalities, especially in cardiac patients. Although low molecular weight HES (130/0.4) has been developed to minimize its influence on coagulation, experience with HES (130/0.4) in children is limited. Therefore, we evaluated the effects of a HES (130/0.4) infusion on post-operative blood loss in children undergoing cardiac surgery. Methods: Forty-two children undergoing cardiac surgery were assigned at random to receive either 10 ml/kg fresh frozen plasma (FFP group; n = 21) or HES (130/0.4) (HES group; n = 21) shortly after cardiopulmonary bypass termination. Activated partial thromboplastin time (aPTT) and international normalization ratio (INR) were measured. In addition, post-operative transfusion requirements and blood loss until the end of the first post-operative day were compared. Results: INR was significantly prolonged after HES infusion in comparison to the FFP group (P < 0.05). During the first 24 h after surgery, post-operative blood loss, the use of allogenic blood/blood products and aPTT were similar in all children. Conclusions: Our study shows that the administration of a moderate dose of HES (130/0.4) in children undergoing cardiac surgery does not cause more bleeding or a higher transfusion requirement than a FFP infusion, and suggests that the administration of 10 ml/kg HES (130/0.4) is a safe alternative to plasma for intravascular volume replacement in this patient population.