This is not the most recent version of the article. View current version (9 NOV 2011)
Human albumin solution for resuscitation and volume expansion in critically ill patients
Editorial Group: Cochrane Injuries Group
Published Online: 18 OCT 2004
Assessed as up-to-date: 15 JUN 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
The Albumin Reviewers (Alderson P, Bunn F, Li Wan Po A, Li L, Pearson M, Roberts I, Schierhout G). Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD001208. DOI: 10.1002/14651858.CD001208.pub2.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 18 OCT 2004
This is not the most recent version of the article. View current version (09 NOV 2011)
Human albumin solutions are used in a range of medical and surgical problems. Licensed indications are the emergency treatment of shock and other conditions where restoration of blood volume is urgent, burns, and hypoproteinaemia. Human albumin solutions are more expensive than other colloids and crystalloids.
To quantify the effect on mortality of human albumin and plasma protein fraction (PPF) administration in the management of critically ill patients.
We searched the Cochrane Injuries Group trials register, CENTRAL (The Cochrane Library issue 2, 2008), MEDLINE, EMBASE, BIDS Index to Scientific and Technical Proceedings, ISI Web of Knowledge: Science Citation Index, Zetoc. Reference lists of trials and review articles were checked, and authors of identified trials were contacted. The search was last updated in June 2008.
Randomised controlled trials comparing albumin/PPF with no albumin/PPF, or with a crystalloid solution, in critically ill patients with hypovolaemia, burns or hypoalbuminaemia.
Data collection and analysis
We collected data on the participants, albumin solution used, mortality at the end of follow up, and quality of allocation concealment. Analysis was stratified according to patient type.
We found 37 trials meeting the inclusion criteria and reporting death as an outcome. There were 1686 deaths among 8716 trial participants.
For hypovolaemia, the relative risk of death following albumin administration was 1.01 (95% confidence interval 0.93 to 1.11). This estimate was heavily influenced by the results of the SAFE trial which contributed 88.2% of the information (based on the weights in the meta-analysis). For burns, the relative risk was 2.52 (1.22 to 5.22) and for hypoalbuminaemia the relative risk was 1.20 (0.87 to 1.64). There was no substantial heterogeneity between the trials in the various categories (chi-square = 25.25, df = 30, p = 0.71). The pooled relative risk of death with albumin administration was 1.04 (0.96 to 1.13).
For patients with hypovolaemia, there is no evidence that albumin reduces mortality when compared with cheaper alternatives such as saline. There is no evidence that albumin reduces mortality in critically ill patients with burns and hypoalbuminaemia. The possibility that there may be highly selected populations of critically ill patients in which albumin may be indicated remains open to question. However, in view of the absence of evidence of a mortality benefit from albumin and the increased cost of albumin compared to alternatives such as saline, it would seem reasonable that albumin should only be used within the context of well concealed and adequately powered randomised controlled trials.
Plain language summary
There is no evidence that giving human albumin to replace lost blood in critically ill or injured people improves survival when compared to giving saline
Trauma, burns or surgery can cause people to lose large amounts of blood. Fluid replacement, giving fluids intravenously (into a vein), is used to help restore blood volume and hopefully reduce the risk of dying. Blood products (including human albumin), non-blood products or combinations can be used. The review of trials found no evidence that albumin reduces the risk of dying. Albumin is very expensive in which case it may be better to use cheaper alternatives such as saline for fluid resuscitation.