Fluid Management in Cardiac Surgery: Results of a Survey in European Cardiac Anesthesia Departments

OBJECTIVE: To evaluate the current practice of perioperative fluid management in cardiac surgery patients.

DESIGN: Multiple choice survey with 26 questions about existing practice of perioperative fluid management in cardiac surgery patients.

SETTING: Online survey.

PARTICIPANTS: Representatives of anesthesia departments in European cardiac surgical centers.

INTERVENTION: None.

MEASUREMENTS AND MAIN RESULTS: The study comprised 106 respondents from 18 European countries who mainly worked in teaching hospitals (66%). In 73% of institutions, patients were admitted to a cardiac surgery intensive care unit (ICU) postoperatively. Perfusionists were responsible for the cardiopulmonary bypass priming solution, whereas anesthesiologists were responsible for intraoperative and postoperative fluid management. For cardiopulmonary bypass priming, balanced crystalloids were used in 51.5% of the centers, whereas in 36%, a combination of crystalloid with either synthetic colloid or albumin was administered. Intraoperatively, balanced crystalloids were used by 74% of centers, followed by a combination of crystalloids with synthetic colloids (15%) and other combinations (11%). No colloids were used by 32% of respondents. When colloids were used, gelatin was preferred, compared with hydroxyethyl starches and albumin (60% v 24% v 16%, respectively). Seventy-three percent of respondents, also involved in ICU treatment, did not change their fluid strategy in the ICU compared with their intraoperative strategy. Thirty-two percent of those who changed their strategy either added (32%) or decreased (29%) synthetic colloids or added (32%) or decreased (7%) natural colloids.

CONCLUSIONS: Perioperative fluid management in cardiac surgery patients may have changed in the last few years in European centers. Balanced crystalloids now seem to be the preferred solutions, followed by synthetic colloids (mainly gelatins) and albumin.