Albumin use in neurosurgery patients

Introduction: Findings from a recent meta-analysis suggested increased patient mortality with albumin administration. An FDA alert was issued advising adherence to University Hospital Consortium (UHC) guidelines for albumin administration. These guidelines do not support albumin use in neurosurgery. The purpose of this investigation was to determine the effect of the FDA alert on albumin use in neurosurgery patients. Methods: Members of the American Brain Injury Consortium Group were surveyed for feedback on 1) the meta-analysis, 2) the FDA position, 3) UHC guidelines, 4) albumin administration, 5) fluids of choice for vasospasm, and 6) a multi-center investigation to answer the safety and efficacy of albumin in neurosurgery patients. A copy of the meta-analysis, the FDA alert, and the UHC guidelines accompanied each survey. Results were collated and entered into the ABIC data bank. Results: Fifty members responded. Nineteen members were aware of the FDA position. The meta-analysis was considered relevant to neurosurgery patients by 50% of respondents and 50% agreed with UHC guidelines. Crystalloid was the fluid of choice for vasospasm in 52% and 14% used albumin. Ninety-three percent of respondents were supportive of a multi-center comparative investigation comparing albumin and crystalloid for treatment of vasospasm. Conclusions: No definitive trials have established optimal fluid choice for vasospasm. Intracranial bleeding is a concern with other colloid products. The UHC position, the meta-analysis, and the FDA request for further studies into albumin appropriateness support the need for a multicenter prospective randomized clinical trial to determine optimal fluid selection for patients with vasospasm.