https://doi.org/10.1177/0267659117746235 Perfusion 1–7 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659117746235 journals.sagepub.com/home/prf Introduction Hemodilution and hypothermia, together with a general inflammatory reaction, contribute to an increased fluid extravasation at the capillary level during cardiopulmo- nary bypass (CPB). A result may be tissue edema, which, occasionally, may affect organ function and might increase both morbidity and mortality. 1,2 Measures to reduce CPB-associated fluid loading should, conse- quently, be sought in order to improve patient outcome. Hyper-oncotic and iso-oncotic hydroxyethyl starch preparations (HES) have been used for this purpose. 3,4 These solutions have, however, more recently, been asso- ciated with kidney dysfunction and a possible negative impact on coagulation. On the other hand, in recent meta-analyses, serious adverse effects of HES could not be demonstrated during cardiac surgery 5 or during surgery in general. 6 In addition, a recent prospective, multi-center cohort study could not confirm an increased risk of acute kidney injury (AKI) or renal replacement therapy after cardiac surgery and use of HES. 7 Is the use of hydroxyethyl starch as priming solution during cardiac surgery advisable? A randomized, single-center trial Øyvind S. Svendsen, 1 Marit Farstad, 1 Arve Mongstad, 2 Rune Haaverstad, 2,3 Paul Husby 1,4 and Venny L. Kvalheim 2,3 Abstract Introduction: The use of cardiopulmonary bypass (CPB) leads to increased fluid filtration and edema. The use of artificial colloids to counteract fluid extravasation during cardiac surgery is controversial. Beneficial effects on global fluid loading, leading to better cardiac performance and hemodynamics, have been claimed. However, renal function and coagulation may be adversely affected, with unfavorable impact on outcome following cardiac surgery. Methods: Forty patients were randomly allocated to study groups receiving either acetated Ringer’s solution (CT group) or hydroxyethyl starch (HES group, Tetraspan ® ) as CPB priming solution. Fluid balance, bleeding and hemodynamics, including cardiac output, were followed postoperatively. The occurrence of acute kidney injury was closely registered. Results: Two patients were excluded from further analyzes due to surgical complications. Fluid accumulation was attenuated in the HES group (3374 (883) ml) compared with the CT group (4328 (1469) ml) (p=0.024). The reduced perioperative fluid accumulation was accompanied by an increased cardiac index immediately after surgery (2.7 (0.4) L/min/m 2 in the HES group and 2.1 (0.3) L/min/m 2 in the CT group (p<0.001)). No increase in bleeding could be demonstrated in the HES group. Three patients, all of them in the HES group, experienced acute kidney injury postoperatively. Conclusions: CPB priming with HES solution lowers fluid loading during bypass and improves cardiac function in the early postoperative period. The manifestation of acute kidney injury exclusively in the HES group of patients raises doubts about the use of HES products in conjunction with cardiac surgery. (https://clinicaltrials.gov/ct2/show/NCT01511120) Keywords hydroxyethyl starch; prime solution; cardiopulmonary bypass; cardiac function; fluid balance; kidney injury 1 Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway 2 Section for Cardiothoracic Surgery, Department for Heart Disease, Haukeland University Hospital, Bergen, Norway 3 Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway 4 Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway Corresponding author: Øyvind S. Svendsen, Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen 5021, Norway. Email: oyvind.sverre.svendsen@helse-bergen.no 746235PRF 0 0 10.1177/0267659117746235PerfusionSvendsen et al. research-article 2017 Original Paper