Cardiology in critical care · Vasoplegia after cardiac surgery
Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery
| Design | Randomised controlled trial |
|---|---|
| Treatment | Vasopressin as first-line vasopressor |
| Control | Noradrenaline as first-line vasopressor |
| Population | 300 patients infused with a study drug for vasoplegic shock after cardiac surgery: 149 vasopressin and 151 noradrenaline |
| Follow-up | Hospital discharge |
| Primary endpoint | Composite of mortality or severe complications within 30 days |
| Result | The primary outcome occurred in 32% of vasopressin patients versus 49% of noradrenaline patients. |
| Secondary endpoints | Atrial fibrillation, acute renal failure, mechanical ventilation time, ICU length of stay |
The authors' results suggest that vasopressin can be used as a first-line vasopressor agent in postcardiac surgery vasoplegic shock and improves clinical outcomes.
The trial authors, in the published abstract
A striking result in a specific setting, and notably at odds with VASST, where vasopressin added to catecholamines in septic shock did nothing. The difference is first-line versus adjunctive use, and vasoplegia after bypass may simply be a different physiological problem.
Hajjar LA, Vincent JL, Barbosa Gomes Galas FR, et al. Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial. Anesthesiology 2017 Jan;126(1):85-93.