BJA open · 2026
Albumin versus crystalloid and microcirculatory blood flow in ischaemia/reperfusion-induced spinal cord injury: a randomised porcine trial.
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Steger Lukas, Umathum Vincent, Bock Katharina, Friedheim Till, Pinnschmidt Hans O, Schänzer Anne, Blaschek Celine, Rehders Johanna, Pantel Tobias, Schulte-Uentrop Leonie, Saugel Bernd, Behem Christoph R
Аннотация
BACKGROUND: Spinal cord injury caused by ischaemia/reperfusion is a severe complication of aortic repair surgeries. Albumin may stabilise the endothelial barrier and preserve microcirculatory blood flow more effectively than crystalloids. This study tested whether albumin-based fluid therapy improves spinal cord microcirculation compared with crystalloid-based therapy in a porcine ischaemia/reperfusion model.
METHODS: Forty Duroc pigs were randomly assigned to receive albumin-based or crystalloid-based fluid therapy. Ischaemia/reperfusion injury was induced by 45 min of supracoeliac aortic cross-clamping. The primary outcome was spinal cord microcirculatory blood flow 4.5 h after the intervention. Secondary outcomes included spinal cord tissue oxygenation, somatosensory-evoked potentials, histopathology, and macrohaemodynamic variables.
RESULTS: Mean spinal cord microcirculatory blood flow (327.2 [95% confidence interval: 228.8-425.6] vs 276.9 [178.5-375.3] arbitrary unit [a.u.]) and tissue oxygenation (52.4 [39.4-65.5] vs 44.0 [31.8-56.2] %) did not differ significantly between albumin- and crystalloid-treated pigs. Somatosensory-evoked potential amplitudes of the tibial nerves (0.161 [0.082-0.241] vs 0.167 [0.082-0.253] μV) and the number of hypoxic neurons (2.69 [0.2-6.2] vs 2.58 [0.3-7.2] per mm2) were also similar in groups.
CONCLUSIONS: Albumin-based fluid therapy did not improve spinal cord microcirculatory blood flow, oxygenation, or histopathological and functional outcomes compared with crystalloid-based therapy in this porcine model of ischaemia/reperfusion-induced spinal cord injury. This trial suggests testing whether albumin can improve spinal cord microcirculatory blood flow in trials in patients is not warranted.
CLINICAL TRIAL NUMBER AND REGISTRY URL: AnimalStudyRegistry.org, https://doi.org/10.17590/asr.0000297.
METHODS: Forty Duroc pigs were randomly assigned to receive albumin-based or crystalloid-based fluid therapy. Ischaemia/reperfusion injury was induced by 45 min of supracoeliac aortic cross-clamping. The primary outcome was spinal cord microcirculatory blood flow 4.5 h after the intervention. Secondary outcomes included spinal cord tissue oxygenation, somatosensory-evoked potentials, histopathology, and macrohaemodynamic variables.
RESULTS: Mean spinal cord microcirculatory blood flow (327.2 [95% confidence interval: 228.8-425.6] vs 276.9 [178.5-375.3] arbitrary unit [a.u.]) and tissue oxygenation (52.4 [39.4-65.5] vs 44.0 [31.8-56.2] %) did not differ significantly between albumin- and crystalloid-treated pigs. Somatosensory-evoked potential amplitudes of the tibial nerves (0.161 [0.082-0.241] vs 0.167 [0.082-0.253] μV) and the number of hypoxic neurons (2.69 [0.2-6.2] vs 2.58 [0.3-7.2] per mm2) were also similar in groups.
CONCLUSIONS: Albumin-based fluid therapy did not improve spinal cord microcirculatory blood flow, oxygenation, or histopathological and functional outcomes compared with crystalloid-based therapy in this porcine model of ischaemia/reperfusion-induced spinal cord injury. This trial suggests testing whether albumin can improve spinal cord microcirculatory blood flow in trials in patients is not warranted.
CLINICAL TRIAL NUMBER AND REGISTRY URL: AnimalStudyRegistry.org, https://doi.org/10.17590/asr.0000297.