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Title: Plasma-Lyte 148 vs. Hartmann's solution for cardiopulmonary bypass pump prime: a prospective double-blind randomized trial
Austin Authors: Weinberg, Laurence ;Chiam, Elizabeth;Hooper, James;Liskaser, Frank;Hawkins, Angela Kim;Massie, Denise;Ellis, Andrew;Tan, Chong O ;Story, David A ;Bellomo, Rinaldo 
Affiliation: Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Clinical Pharmacology and Therapeutics, Austin Hospital, Heidelberg, Victoria, Australia
Anesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Victoria, Australia
Department of Intensive Care, The University of Melbourne, Victoria, Australia
Issue Date: May-2018
Date: 2017-11-01
Publication information: Perfusion 2018; 33(4): 310-319
Abstract: BACKGROUND: The mechanisms of acid-base changes during cardiopulmonary bypass (CPB) remain unclear. We tested the hypothesis that, when used as CPB pump prime solutions, Plasma-Lyte 148 (PL) and Hartmann's solution (HS) have differential mechanisms of action in their contribution to acid-base changes. METHODS: We performed a prospective, double-blind, randomized trial in adult patients undergoing elective cardiac surgery with CPB. Participants received a CPB prime solution of 2000 mL, with either PL or HS. The primary endpoint was the standard base excess (SBE) value measured at 60 minutes after full CPB flows (SBE60min). Secondary outcomes included changes in SBE, pH, chloride, sodium, lactate, gluconate, acetate, strong ion difference and strong ion gap at two (T2min), five (T5min), ten (T10min), thirty (T30min) and sixty (T60min) minutes on CPB. The primary outcome was measured using a two-tailed Welch's t-test. Repeated measures ANOVA was used to test for differences between time points. RESULTS: Twenty-five participants were randomized to PL and 25 to HS. Baseline characteristics, EURO and APACHE scores, biochemistry, hematology and volumes of cardioplegia were similar. Mean (SD) SBE at T60min was -1.3 (1.4) in the PL group and -0.1 (2.7) in the HS group; p=0.55. No significant differences in SBE between the groups was observed during the first 60 minutes (p=0.48). During CPB, there was hyperacetatemia and hypergluconatemia in the PL group and hyperlactatemia and hyperchloremia in the HS group. No significant difference between the groups in plasma bicarbonate levels and total weak acid levels were found. Complications and intensive care unit and hospital length of stays were similar. CONCLUSIONS: During CPB, PL and HS did not cause a significant metabolic acidosis. There was hyperacetatemia and hypergluconatemia with PL and hyperchloremia and hyperlactatemia with HS. These physiochemical effects appear clinically innocuous.
DOI: 10.1177/0267659117742479
ORCID: 0000-0001-7403-7680
Journal: Perfusion
PubMed URL: 29144182
PubMed URL:
Type: Journal Article
Subjects: Hartmann’s solution
acid base
cardiac prime
cardiopulmonary bypass
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