Vasopressor Therapy in Cardiac Surgery—An Experts’ Consensus Statement

Abstract

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Commentary: Is angiotensin II a game changer for vasoplegia after cardiac surgery, or is the jury still out?

“…Indeed, the relative paucity of high-quality studies in this field is underscored by a recent consensus statement whose major (but limited) conclusions (use norepinephrine or vasopressin, avoid dopamine) were based on moderatequality evidence at best. 2 Ever more studies are investigating the use of Ang-II in various contexts after cardiac surgery 3 and even thoracoabdominal aortic aneurysm repair. 4 In the landmark Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) trial, patients were randomized to Ang-II or standard of care vasopressors; the primary endpoint was a mean arterial pressure >75 mm Hg within 3 hours.…”

Commentary: Angiotensin II: Expanding the rescue options for vasoplegia

“…Given the serious effects of vasoplegia on outcomes after cardiothoracic surgery, clinical rescue remains a priority in perioperative management. 1,2 The knowledge gaps in the pathogenesis of this syndrome have prompted calls for further investigation to solve this complex puzzle, including the roles of the renin-angiotensin-aldosterone system. [3][4][5] In this issue of the Journal, Chow and colleagues 5 evaluate the evidence supporting angiotensin II for vasoplegic rescue in cardiothoracic surgery.…”

Vasoplegic syndrome after cardiovascular surgery: A review of pathophysiology and outcome‐oriented therapeutic management

“…B-blockers have also previously been reported to protect against vasoplegia. 10,11,36 A comprehensive list of all these agents is presented in Table 1.…”

“…The effective dose of NE infusion for restoration and maintenance of systemic perfusion pressure is 0.025-0.2 µg/kg/ min. However, some authors have used higher doses (0.1 and 0.7 µg/ kg/min) to maintain a MAP between 55 and 70 mmHg in VPS after CPB 36. Norepinephrine has numerous advantages over the other vasopressors: (a) a very potent vasopressor effect equivalent38 Epinephrine, conversely, may worsen heart rate, myocardial oxygen consumption, and the likelihood of arrhythmia, and phenylephrine may worsen systole-diastolic function and ventriculoarterial coupling 38,39.…”