• Hanna Vlasov, Erika Wilkman, Liisa Petäjä, Raili Suojaranta, Seppo Hiippala, Hanna Tolonen, Mikko Jormalainen, Peter Raivio, Tatu Juvonen, and Eero Pesonen.
• Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: hanna.vlasov@hus.fi.
• J. Cardiothorac. Vasc. Anesth. 2024 Oct 1; 38 (10): 226922772269-2277.

ObjectivesCompare hemodynamics between 4% albumin and Ringer's acetate.DesignExploratory analysis of the double-blind randomized ALBumin In Cardiac Surgery trial.SettingSingle-center study in Helsinki University Hospital.ParticipantsWe included 1,386 on-pump cardiac surgical patients.InterventionWe used 4% albumin or Ringer's acetate administration for cardiopulmonary bypass priming, volume replacement intraoperatively and 24 hours postoperatively.Measurements And Main ResultsHypotension (time-weighted average mean arterial pressure of <65 mmHg) and hyperlactatemia (time-weighted average blood lactate of >2 mmol/L) incidences were compared between trial groups in the operating room (OR), and early (0-6 hours) and late (6-24 hours) postoperatively. Associations of hypotension and hyperlactatemia with the ALBumin In Cardiac Surgery primary outcome (≥1 major adverse event [MAE]) were studied. In these time intervals, hypotension occurred in 118, 48, and 17 patients, and hyperlactatemia in 313, 131, and 83 patients. Hypotension and hyperlactatemia associated with MAE occurrence. Hypotension did not differ between the groups (albumin vs Ringer's: OR, 8.8% vs 8.5%; early postoperatively, 2.7% vs 4.2%; late postoperatively, 1.2% vs 1.3%; all p > 0.05). In the albumin group, hyperlactatemia was less frequent late postoperatively (2.9% vs 9.1%; p < 0.001), but not earlier (OR, 22.4% vs 23.6%; early postoperatively, 7.9% vs 11.0%; both p > 0.025 after Bonferroni-Holm correction).ConclusionsIn on-pump cardiac surgery, hypotension and hyperlactatemia are associated with the occurrence of ≥1 MAE. Compared with Ringer's acetate, albumin did not decrease hypotension and decreased hyperlactatemia only late postoperatively. Albumin's modest hemodynamic effect is concordant with the finding of no difference in MAEs between albumin and Ringer's acetate in the ALBumin In Cardiac Surgery trial.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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