A predictive model for prudent albumin priming in cardiopulmonary bypass circuits.

backgroundDosing albumin to normalize colloid osmotic pressure is an underutilized strategy within the application of cardiopulmonary bypass. The negative sequelae of third-spacing and edema post-bypass are well known and documented within the literature, yet it is not common practice for perfusionists to calculate albumin dilution or tailor albumin administration to each individual patient.

methodsThe author explored relevant literature to justify quantifying albumin dosing and concentration within the application of cardiopulmonary bypass. Sequelae following edema in the cardiac patient were also explored and presented, justifying the investigation of this topic. Formulas to quantify albumin dilution, resultant drop in colloid osmotic pressure, and suggested albumin dosing, were presented and unified into a model.

resultsA spreadsheet-based model was developed to quantify albumin dilution that may be accessed or recreated by the reader for information purposes or for clinical use. This model enables the user to solely quantify their albumin dilution during bypass, or more proactively calculate albumin concentration and dosing in an attempt to mitigate large colloid osmotic pressure changes during bypass.

conclusionsIntentional albumin management can yield more physiologically normal albumin concentrations and colloid osmotic pressures undergoing cardiopulmonary bypass, reducing the sequelae previously described. The model presented enables informed albumin dosing by the perfusionist, and use of this model may be of especially great benefit to patients who are hypovolemic, underweight, or pediatric.