Table 3.
Recommendations for use of human serum albumin (HSA) in adult cardiac surgery.
| No. | Recommendations | COR | LOE | References |
|---|---|---|---|---|
| Section 1. Volume replacement | ||||
| 1 A comprehensive multimodality approach by a multidisciplinary team is recommended to minimize hemodilution during cardiac surgery. | I | C-EO | 5, 39–45 | |
| 2 Goal-directed fluid therapy is recommended to assess the volume status and optimize fluid resuscitation during and after cardiac surgery. | I | B-NR | 46–50 | |
| 3 It is reasonable to administer HSA following crystalloid resuscitation in patients who need further volume replacement during and after cardiac surgery to avoid excessive positive fluid balance. | IIb | B-NR | 13, 19, 21–23, 32, 51–59, 61 | |
| 4 HSA infusion might be helpful to maintain intravascular volume and arterial pressure when aggressive diuresis is given to relieve fluid overload and interstitial edema after cardiac surgery. Hypertonic (20% or 25%) HSA is preferred in this setting. | IIb | C-LD | 19,20,62–66 | |
| 5 HSA is not routinely recommended as the first-line choice of fluid resuscitation during and after cardiac surgery. | III: No Benefit | B-R | 32, 58, 60,67–69 | |
| 6 Using HSA for fluid resuscitation in patients with hemorrhagic shock and uncontrolled bleeding is not recommended. | III: No Benefit | C-EO | None | |
| 7 HSA infusion is reasonable to supplement prior volume and albumin loss in patients with bleeding-controlled hemorrhagic stroke. | IIa | C-EO | None | |
| Section 2. Pump priming | ||||
| 8 Pump priming with HSA for optimizing blood management might be reasonable. | IIb | B-NR | 9, 32, 37–39, 61, 70–76 | |
| 9 Pump priming with HSA might be considered in specific cardiac surgical populations, such as those undergoing heart transplantation, pulmonary thromboembolectomy, and deep hypothermia circulatory arrest. | IIb | C-EO | None | |
| Section 3. Correction of hypoalbuminemia | ||||
| 10 HSA infusion is reasonable to correct preoperative hypoalbuminemia in normovolemic patients. | IIb | B-NR | 31, 77–83 | |
| 11 Correcting postoperative hypoalbuminemia by HSA infusion in normovolemic patients might be beneficial. | IIb | C-EO | None | |
COR: Class of recommendations; EO: Expert opinion; LD: Limited data; LOE: Level of evidence; NR: Nonrandomized; R: Randomized.