Factors associated with vasoplegic shock in the postoperative period of cardiac surgery and influence on morbidity and mortality of the use of arginine vasopressin as rescue therapy

María Barrera Sánchez; Cristina Royo Villa; Pablo Ruiz de Gopegui Miguelena; Pablo Gutiérrez Ibañes; Andrés Carrillo López

doi:10.1016/j.medine.2024.04.003

Factors associated with vasoplegic shock in the postoperative period of cardiac surgery and influence on morbidity and mortality of the use of arginine vasopressin as rescue therapy

Med Intensiva (Engl Ed). 2024 May 1:S2173-5727(24)00081-X. doi: 10.1016/j.medine.2024.04.003. Online ahead of print.

Authors

María Barrera Sánchez¹, Cristina Royo Villa¹, Pablo Ruiz de Gopegui Miguelena², Pablo Gutiérrez Ibañes¹, Andrés Carrillo López¹

Affiliations

¹ Hospital Universitario Miguel Servet, Zaragoza, Spain.
² Hospital Universitario Miguel Servet, Zaragoza, Spain. Electronic address: pruizdegopegui@salud.aragon.es.

PMID: 38697904
DOI: 10.1016/j.medine.2024.04.003

Abstract

Objectives: Analyzing associated factors with vasoplegic shock in the postoperative period of Cardiac Surgery. Analyzing the influence of vasopressin as rescue therapy to first-line treatment with norepinephrine.

Design: Cohort, prospective and observational study.

Setting: Main hospital Postoperative Cardiac ICU.

Patients: Patients undergoing cardiac surgery with subsequent ICU admission from January 2021 to December 2022.

Interventions: Record of presurgical, perioperative and ICU discharge clinical variables.

Main variables of interest: chronic treatment, presence of vasoplegic shock, need for vasopressin, cardiopulmonary bypass time, mortality.

Results: 773 patients met the inclusion criteria. The average age was 67.3, with predominance of males (65.7%). Post-CPB vasoplegia was documented in 94 patients (12.2%). In multivariate analysis, vasoplegia was associated with age, female sex, presurgical creatinine levels, cardiopulmonary bypass time, lactate level upon admission to the ICU, and need for prothrombin complex transfusion. Of the patients who developed vasoplegia, 18 (19%) required rescue vasopressin, associated with pre-surgical intake of ACEIs/ARBs, worse Euroscore score and longer cardiopulmonary bypass time. Refractory vasoplegia with vasopressin requirement was associated with increased morbidity and mortality.

Conclusions: Postcardiopulmonary bypass vasoplegia is associated with increased mortality and morbidity. Shortening cardiopulmonary bypass times and minimizing products blood transfusion could reduce its development. Removing ACEIs and ARBs prior to surgery could reduce the incidence of refractory vasoplegia requiring rescue with vasopressin. The first-line treatment is norepinephrine and rescue treatment with VSP is a good choice in refractory situations. The first-line treatment of this syndrome is norepinephrine, although rescue with vasopressin is a good complement in refractory situations.

Keywords: Bypass cardiopulmonar; Cardiac surgery; Cardio-pulmonary bypass; Cirugía cardíaca; Noradrenalina; Norepinephrine; Síndrome vasopléjico; Vasoplegic syndrome; Vasopresina; Vasopressin.