Comparison of 6% hydroxyethyl starch 130/0.4 vs 5% albumin in cardiopulmonary bypass for cardiac surgery

Table 1 Baseline characteristics of the included studies

Ref.	Centers	HES (n)	Albumin (n)	Area/country	Gender male/female (HES vs albumin)	Age (years) (HES vs albumin)	HES concentration	Albumin concentration	CPB time (min) (HES vs albumin)	Type of surgery	Purpose
Cho et al[17], 2014	Single	18	18	Korea	7/11 vs 7/11	57 ± 17 vs 64 ± 13	6% 130/0.4	5%	110 ± 35 vs 115 ± 40	Complex cardiac surgery	Priming solution
Choi et al[18], 2010	Single	20	20	South Korea	5/13 vs 6/12	54 ± 12 vs 55 ± 14	6% 130/0.4	5%	120 ± 40 vs 125 ± 45	Elective mitral valvular heart surgery with CPB	Priming solution
Duncan et al[19], 2020	Single	69	72	America	47/22 vs 44/28	71 ± 10 vs 69 ± 9	6% 130/0.4	5%	105 ± 30 vs100 ± 25	Elective aortic valve replacement	Volume replacement
Hanart et al[20], 2009	Single	60	59	Italy	32/28 vs 38/21	1.67 (0.67-3.83) vs 0.91 (0.42-3.5)	6% 130/0.4	4%	70 ± 25 vs 65 ± 20	Congenital heart disease necessitating CPB	Intraoperative fluid volume replacement
Hosseini et al[25], 2024	Single	20	20	Iran	17/3 vs 16/4	63.05 ± 5.92 vs 66.45 ± 5.84	6% (unspecified molar ratio)	20%	89.28 ± 32.06 vs 94.36 ± 29.16	CABG surgery	Priming solutions
Lee et al[27], 2021	Single	66	69	America	45/21 vs 43/26	70 ± 10 vs 68 ± 9	6% 130/0.4	5%	105 ± 30 vs 100 ± 25	Elective aortic valve replacement	Volume replacement
Hosseinzadeh Maleki et al[22], 2016	Single	30	30	Iran	17/13 vs 21/9	61.85 ± 9.10 vs 66.07 ± 8.82	6% 130/0.4	5%	95 ± 35 vs 90 ± 30	Elective coronary artery bypass grafting surgery	Priming solutions
Niemi et al[23], 2008	Single	10	10	Finland	9/6 vs 11/4	61 (31-78) vs 59 (34-73)	6% 130/0.4	5%	100 ± 25 vs 95 ± 20	On-pump cardiac surgery	Infusion fluid
Patel et al[24], 2016	Single	35	35	India	24/11 vs 21/14	16.20 ± 14.24 vs 15.80 ± 13.11	6% 130/0.4	4%	85 ± 30 vs 80 ± 25	Cardiac surgery with CPB	Priming solution
Schramko et al[26], 2009	Single	15	15	Finland	11/4 vs 9/6	61 (48) vs 59 (39)	6% 130/0.4	4%	110 ± 35 vs 105 ± 30	Elective primary cardiac surgery	Infusion fluid
Skhirtladze et al[3], 2014	Single	81	76	Austria	52/29 vs 53/23	67 (28-87) vs 66 (23-85)	6% 130/0.4	5%	115 ± 40 vs 110 ± 35	Elective cardiovascular surgery with CPB	Infusion fluid
Van der Linden et al[21], 2013	Two-center	31	29	Belgium and Austria	17/13 vs 15/16	4.0 (2-9) vs 5.2 (2-12)	6% 130/0.4	5%	60 ± 20 vs 55 ± 15	Elective cardiac surgery for congenital heart disease requiring extracorporeal circulation	Volume replacement

Data are presented as mean ± SD. HES: Hydroxyethyl starch; CPB: Cardiopulmonary bypass; CABG: Coronary artery bypass graft.

Table 2 Grading of Recommendations Assessment, Development and Evaluation assessment of the clinical outcomes

Outcome	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Overall certainty of evidence
Postoperative platelet count (109/L, 24 h postop)	Serious	Serious1 (I2 = 49%, P = 0.08)	Not serious	Not serious (CI narrow, does not cross MID)	Undetected	Moderate
Postoperative creatinine (mg/dL, 24 h postop)	Serious	Not serious (I2 = 0%, P = 0.53)	Not serious	Not serious (CI narrow)	Undetected	High
ICU days	Serious	Not serious (I2 = 0%, P = 0.96)	Not serious	Serious (CI wide)	Undetected	Moderate
Hospital days	Serious	Serious (I2 = 61%, P = 0.05)	Not serious	Serious (CI wide)	Undetected	Low
Patients receiving pRBC transfusion	Serious	Serious (I2 = 65%, P = 0.01)	Not serious	Not serious (CI does not cross 25% relative risk)	Undetected	High
Acute kidney injury	Serious	Not serious (I2 = 38%, P = 0.20)	Not serious	Serious (CI wide, few events)	Undetected	High
Mortality	Serious	Not serious (I2 = 0%, P = 0.80)	Not serious	Very serious (very wide CI, very few events)	Undetected	High
Postoperative blood loss (mL)	Serious	Very serious (I2 = 81%, P = 0.00)	Not serious	Not serious (CI narrow)	Undetected	Moderate

CI: Confidence interval; MID: Minimum important difference; ICU: Intensive care unit; pRBC: Packed red blood cell.