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CPB prime: Additives

The norm for cardiopulmonary bypass (CPB) priming solution is crystalloid. Although there is institutional variation, it generally has a similar electrolyte content and osmolarity as plasma. One result of the hemodilution that occurs is a decrease in the plasma colloidal oncotic pressure from dilution of plasma proteins, which can lead to postoperative edema. Use of colloidal solutions including 5% and 25% albumin, low and high molecular weight dextran, 5% plasma protein fraction, 6% hydroxyethyl starch, and human plasma has shown differences in lung water or total body water immediately after bypass but this effect declines in the immediate postoperative period.

Other additives may include:

  • Heparin to provide additional safety factor to systemic heparinization.
  • Calcium to compensate for chelation of calcium if citrated blood is added to prime.
  • Mannitol to attenuate tissue edema and induce osmotic diuresis
  • Corticosteroids to diminish inflammatory response caused by CPB