Evaluation of Vasopressin for Vasoplegic Shock in Patients With Preoperative Left Ventricular Dysfunction After Cardiac Surgery: A Propensity-Score Analysis

Cheng, Yu‐Shia; Pan, Tuo; Ge, Min; Chen, Tao; Ye, Jia-Xin; Lu, Lichong; Chen, Cheng; Zong, Qiuyan; Ding, Yi; Wang, Dongjin

doi:10.1097/shk.0000000000001114

Cited by 23 publications

(12 citation statements)

References 17 publications

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“…Therefore, we defined "MIRCS" as a composite of criteria related to myocardial injury. The criteria were consistent with any of the following conditions: ① impaired ventricular function (cardiac index at the end of surgery< 2.2 L/m2/min) [14,15]; ② poor perfusion (arterial lactate level at the end of surgery> 5 mmol/L) [14]; ③ need for a large number of vasoactiveinotropic drugs (vasoactive-inotropic score at the end of surgery≥40) [14,16] after the correction of all electrolytes and blood gas abnormalities while adjusting preload volume to optimal values; and ④ a cardiac troponin T (cTnT) level at 24 h after CPB ≥0.8 μg/L and an increase of more than 10% from 24 h after CPB to 48 h after CPB [17][18][19][20]. The diagnosis of MIRCS was confirmed when all 4 criteria were met.…”

Section: Study Design and Settingsmentioning

confidence: 99%

Heparin-binding protein measurement improves the prediction of myocardial injury-related cardiogenic shock

Pan

Long

Chen

et al. 2020

BMC Cardiovasc Disord

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Background: Heparin-binding protein (HBP), a potent inducer of increased vascular permeability, is a potentially useful biomarker for predicting outcomes in patients with postoperative myocardial injury-related cardiogenic shock (MIRCS). We aimed to evaluate and validate HBP as a prognostic biomarker for postoperative MIRCS. Methods: We performed a case-control study in 792 patients undergoing cardiac surgery from January 1, 2016, to August 1, 2019, including 172 patients with postoperative MIRCS and 620 age-and sex-matched controls. The association between HBP and MIRCS was determined by multivariate logistic regression analysis. Receiver operating characteristic curves (ROCs) with area under the curve (AUC) were performed to calculate the cutoff value, sensitivity and specificity. The association between HBP and cardiac troponin T (cTnT) was determined by multivariable linear regression analysis. Blood samples were drawn from the coronary sinus and arterial line of the cardiopulmonary bypass (CPB) before aortic cross-clamping (time point 1) and 5 min after aortic declamping (time point 2). Results: Before aortic cross-clamping, coronary sinus HBP (HBP CS1) showed no differences between the two groups. However, after declamping, the MIRCS group had a significantly higher sinus HBP level (HBP CS2) than did the control group. HBP CS2 predicted MIRCS with an AUC of 0.85 (95% CI: 0.81-0.89, cutoff: 220 ng/ml, sensitivity: 92% and specificity: 70%). After adjusting for confounding factors, we found that HBP was an independent risk factor for MIRCS (OR: 7.65, 95% CI: 4.86-12.06, P < 0.01) and was positively associated with cTnT (β > 0, P < 0.01). Conclusions: Elevated levels of coronary sinus HBP were useful biomarkers for predicting MIRCS after cardiac surgery.

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Section: Study Design and Settingsmentioning

confidence: 99%

Heparin-binding protein measurement improves the prediction of myocardial injury-related cardiogenic shock

Pan

Long

Chen

et al. 2020

BMC Cardiovasc Disord

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“…At this time, there is no established first-line vasopressor for vasoplegia following CPB. 12,[23][24][25][26][27] Sympathomimetic agents, such as norepinephrine, epinephrine, and phenylephrine, are commonly used. Norepinephrine is an alpha-1 and beta-1 adrenergic receptor agonist.…”

Section: Vasopressorsmentioning

confidence: 99%

Vasoplegia after cardiopulmonary bypass: A narrative review of pathophysiology and emerging targeted therapies

2020

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Cardiovascular disease remains the leading cause of death in the United States, and cardiopulmonary bypass is a cornerstone in the surgical management of many related disease states. Pathophysiologic changes associated both with extracorporeal circulation and shock can beget a syndrome of low systemic vascular resistance paired with relatively preserved cardiac output, termed vasoplegia. While increased vasopressor requirements accompany vasoplegia, related pathophysiologic mechanisms may also lead to true catecholamine resistance, which is associated with further heightened mortality. The introduction of a second non-catecholamine vasopressor, angiotensin II, and non-specific nitric oxide scavengers offers potential means by which to manage this challenging phenomenon. This narrative review addresses both the definition, risk factors, and pathophysiology of vasoplegia and potential therapeutic interventions.

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“…Extracorporeal membrane oxygenation (ECMO) has gained widespread use over the last decade for the treatment of severe cardiorespiratory failure and cardiac arrest. Despite remarkable technical improvements with improved system biocompatibility and centrifugal instead of roller pumps, the outcome of cardiogenic shock, extracorporeal resuscitation and post-cardiotomy shock remains modest at best (6)(7)(8). The physiology of ECMO is incompletely understood and data on hemodynamic support to optimize ECMO-flow with volume or vasopressors for patients on veno-arterial ECMO are scant (6,8).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Vasoconstriction And Volume Expansion on Veno-Arterial ECMO Flow

Möller

Hana

Heinisch

et al. 2019

Shock

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In a circulation completely dependent on ECMO support, maximum achievable flow directly depended on the vascular factors governing venous return - i.e. closing conditions, stressed vascular volume and the elastance and resistive properties of the vasculature. Both treatments increased maximum achievable ECMO flow at stable DO2, via increases in stressed volume by different mechanisms. Vascular resistance and pump afterload decreased with Volume Expansion.

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Evaluation of Vasopressin for Vasoplegic Shock in Patients With Preoperative Left Ventricular Dysfunction After Cardiac Surgery: A Propensity-Score Analysis

Abstract: Compared with norepinephrine, vasopressin could not improve the postoperative outcomes in patients with pLVD after cardiac surgery. Vasopressin should be cautious to be used as a first-line vasopressor agent in postcardiac vasoplegic shock.

Cited by 23 publications

References 17 publications

Heparin-binding protein measurement improves the prediction of myocardial injury-related cardiogenic shock

Heparin-binding protein measurement improves the prediction of myocardial injury-related cardiogenic shock

Vasoplegia after cardiopulmonary bypass: A narrative review of pathophysiology and emerging targeted therapies

The Effects of Vasoconstriction And Volume Expansion on Veno-Arterial ECMO Flow

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