A comparative observational study to assess the effects of three different balanced crystalloid priming solutions on the perioperative parameters and outcome variables in adult patients undergoing cardiac surgery on cardiopulmonary bypass Kumar Sandeep, Prof. Chauhan Sandeep, Prof. Chowdhary Ujjwal, Kumar Alok, Yadav Suresh Chand All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi Online published on 17 October, 2018. Abstract Background As the cardiopulmonary bypass system developed, priming solutions were modified and changed with time. Earliest CPB prime was blood, now balanced crystalloid solution is being used by most of the cardiac centers in the world. Balanced crystalloids are the simple isotonic solutions which mimic osmolarity and electrolytes contains of plasma. Balanced crystalloids also contain anions for bicarbonate production like lactate, acetate, maleate, gluconate etc. These anions play a major role in blood pH management by reducing acidosis. Hemodilution with balanced crystalloid solution results in improved capillary blood flow and oxygen delivery and decreased exposure to donor blood. Methods This study was performed on ninety (90) patients having coronary artery disease who underwent CABG with cardiopulmonary bypass. Patients were randomly divided into three equal groups of 30 patients each, group A (priming solution was Ringer's lactate), group B (balanced crystalloid solution containing acetate and maleate (Sterofundin©)) and group C (balanced crystalloid solution containing acetate and gluconate (Plasma-Lyte A©)). Arterial blood samples were analyzed and recorded before, during and after the surgery in all three groups. Serum osmolarity, urine output, requirements of blood products, inotropic support, RFTs and LFTs were recorded and compared between the groups. Results Group B (Sterofundin) showed higher bicarbonate level (27.26±3.14) and base excess (2.47±2.90) during the perioperative period and had less metabolic acidosis as compared to group A (Ringer's lactate) and group C (Plasmalyte-A). In Group Ccalcium levels during perioperative periodwas significantly lower as compared to both group. Lactate levels were higher in Group A and it was found to be normal range in Group B and Group C.RFTs, LFTs, inotropic support and blood requirement showed non-significant difference between the groups. Conclusion All three balanced crystalloid solutions are safe to use as priming solutions in adult patients undergoing cardiopulmonary bypass. Balanced crystalloid solution containing acetate and maleate (Sterofundin) or acetate and gluconate (Plasmalyte-A) are more effective in bicarbonate production during perioperative period. Hence, there is no need to add sodium bicarbonate as prime additive when acetate, maleate and gluconate containing solutions are used as priming solution. However caution should be taken for serum calcium levels when priming with Plasmalyte-A. Top |