Efficacy and safety of angiotensin II in cardiogenic shock: A systematic review

Am J Emerg Med. 2023 Apr:66:124-128. doi: 10.1016/j.ajem.2023.01.050. Epub 2023 Feb 1.


Background: Cardiogenic shock (CS) is associated with high morbidity and mortality. In recent times, there is increasing interest in the role of angiotensin II in CS. We sought to systematically review the current literature on the use of angiotensin II in CS.

Methods: PubMed, EMBASE, Medline, Web of Science, PubMed Central, and CINAHL databases were systematically searched for studies that evaluated the efficacy of angiotensin II in patients with CS during 01/01/2010-07/07/2022. Outcomes of interest included change in mean arterial pressure (MAP), vasoactive medication requirements (percent change in norepinephrine equivalent [NEE] dose), all-cause mortality, and adverse events.

Results: Of the total 2,402 search results, 15 studies comprising 195 patients were included of which 156 (80%) received angiotensin II. Eleven patients (84.6%) in case reports and case series with reported MAP data at hour 12 noted an increase in MAP. Two studies noted a positive hemodynamic response (defined a priori) in eight (88.9%) and five (35.7%) patients. Eight studies reported a reduction in NEE dose at hour 12 after angiotensin II administration and one study noted a 100% reduction in NEE dose. Out of 47 patients with documented information, 13 patients had adverse outcomes which included hepatic injury (2), digital ischemia (1), ischemic optic neuropathy (1), ischemic colitis (2), agitated delirium (1), and thrombotic events (2).

Conclusions: In this first systematic review of angiotensin II in CS, we note the early clinical experience. Angiotensin II was associated with improvements in MAP, decrease in vasopressor requirements, and minimal reported adverse events.

Keywords: Angiotensin II; Cardiogenic shock; Critical care cardiology; Post-cardiotomy; Vasoplegia.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Angiotensin II / therapeutic use
  • Arterial Pressure
  • Humans
  • Norepinephrine / therapeutic use
  • Peptide Hormones*
  • Shock*
  • Shock, Cardiogenic / etiology
  • Vasoconstrictor Agents / adverse effects


  • Angiotensin II
  • Vasoconstrictor Agents
  • Norepinephrine
  • Peptide Hormones