Hydroxocobalamin treatment of refractory vasoplegia in patients with mechanical circulatory support

Cios, Theodore J.; Havens, Benjamin; Soleimani, Behzad; Roberts, S. Michael

doi:10.1016/j.healun.2019.01.003

Cited by 14 publications

(22 citation statements)

References 4 publications

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“…All patients had sustained hemodynamics with a further decrease in their vasopressor score at 6 hours after hydroxocobalamin administration. Our work supports a recent study that found a similar positive response to hydroxocobalamin administration in a small cohort of LVAD patients experiencing VS 21 …”

Section: Discussionsupporting

confidence: 92%

The use of hydroxocobalamin for vasoplegic syndrome in left ventricular assist device patients

Ayers

Wood

Falvey

et al. 2020

Clinical Case Reports

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Section: Discussionsupporting

confidence: 92%

The use of hydroxocobalamin for vasoplegic syndrome in left ventricular assist device patients

Ayers

Wood

Falvey

et al. 2020

Clinical Case Reports

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“…All of the eight eligible studies were conducted in the United States 22–29 . Six studies were case series, 22,23,26–29 one was a prospective cohort study, 24 and one was a pilot randomized controlled trial (RCT) 25 .…”

Section: Summary Of Literaturementioning

confidence: 99%

“…Six studies were case series, 22,23,26–29 one was a prospective cohort study, 24 and one was a pilot randomized controlled trial (RCT) 25 . A small number of patients received hydroxocobalamin, with numbers ranging from 10 to 35 because of study sample sizes and design 22–29 . The largest study ( N = 88) was a prospective cohort; however, most of these patients were in the propensity‐matched cohort who received methylene blue rather than hydroxocobalamin 24 .…”

Section: Summary Of Literaturementioning

confidence: 99%

Treatment of refractory shock with vitamin B₁₂: A narrative review

Wedemire,

Samavat,

Newkirk

et al. 2023

Nut in Clin Prac

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High‐dose vitamin B12 is a potential treatment for patients with vasodilatory shock that is refractory to other therapies. Vasodilatory shock is characterized by low blood pressure and low systemic vascular resistance. Nitric oxide and hydrogen sulfide, two potential targets of high‐dose vitamin B12 given as hydroxocobalamin, facilitate this syndrome. This review explores the relationship between high‐dose vitamin B12 and hemodynamic outcomes in adults with vasodilatory shock and provides an update on the literature since a 2019 review on this topic. A literature search of studies published in the past 5 years was conducted in the CINAHL, PubMed, Cochrane, and EMBASE databases in May 2023. After assessing for eligibility, eight studies met this review's inclusion criteria. Seven of the eight studies reported decreased vasopressor requirements for part or all of the study samples after receiving a hydroxocobalamin infusion. However, not all patients responded to hydroxocobalamin. These findings are limited by patient selection and differences in the timing of vasopressor requirement and blood pressure outcome assessments. The current evidence is promising as to whether vitamin B12, given as a hydroxocobalamin infusion, may improve hemodynamic outcomes in vasodilatory shock, but the evidence is of low quality. The use of hydroxocobalamin to treat refractory, vasodilatory shock remains investigative. Larger randomized controlled trials are required to elucidate the role of vitamin B12 in treating refractory, vasodilatory shock, including in conjunction with other alternative therapies such as methylene blue and corticosteroids.

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“…Multiple case series have reported very good response in post-transplant, post-bypass, and septic vasoplegia. 36,37 A dose of 5 g infused over 15-30 min and a pediatric dose of 70 mg/kg infused over 15-30 min to a maximum of 5gm has been the reported efficacious dose range. 9.…”

Section: Pharmacologic Managementmentioning

confidence: 99%

“…Hydroxocobalamin: Hydroxocobalamin is a potent scavenger of nitric oxide (NO) and directly inhibits NO synthase, guanylate cyclase, and hydrogen sulfide, which are all inflammatory mediators known to be involved in the pathophysiology of vasoplegic syndrome. Multiple case series have reported very good response in post‐transplant, post‐bypass, and septic vasoplegia 36,37 . A dose of 5 g infused over 15–30 min and a pediatric dose of 70 mg/kg infused over 15–30 min to a maximum of 5gm has been the reported efficacious dose range. Ascorbic acid, thiamine, and corticosteroids: A combination of ascorbic acid, thiamine, and corticosteroids has been shown to be effective in vasodilatory shock including that related to sepsis 37,38 .…”

Section: Managementmentioning

confidence: 99%

Clinical approach to vasoplegia in the transplant patient from the Pediatric Heart Transplant Society

Deshpande

Bearl

Eghtesady

et al. 2022

Pediatric Transplantation

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This manuscript outlines a clinical approach to vasoplegia incorporating the current state of knowledge regarding vasoplegia in pediatric patients immediately posttransplant and to identify modifiable factors both pre-and post-transplant that may reduce post-operative morbidity, end-organ dysfunction, and mortality. Centers participating in the Pediatric Heart Transplant Society (PHTS) were asked to provide their internal protocols and rationale for vasoplegia management, and applicable adult and pediatric data were reviewed. The authors synthesized the above protocols and literature into the following description of clinical approaches to vasoplegia highlighting areas of both broad consensus and of significant practice variation. K E Y W O R D S pediatric heart transplant, post-operative, vasoplegiaThis manuscript is designed the clinical approach to vasoplegia incorporating the current state of knowledge regarding vasoplegia in pediatric patients immediately post-transplant, and to identify modifiable factors both pre-and post-transplant that may help to reduce post-operative morbidity, end-organ dysfunction, and mortality in this subset of patients where this is encountered.

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Hydroxocobalamin treatment of refractory vasoplegia in patients with mechanical circulatory support

Cited by 14 publications

References 4 publications

The use of hydroxocobalamin for vasoplegic syndrome in left ventricular assist device patients

The use of hydroxocobalamin for vasoplegic syndrome in left ventricular assist device patients

Treatment of refractory shock with vitamin B₁₂: A narrative review

Clinical approach to vasoplegia in the transplant patient from the Pediatric Heart Transplant Society

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Hydroxocobalamin treatment of refractory vasoplegia in patients with mechanical circulatory support

Cited by 14 publications

References 4 publications

The use of hydroxocobalamin for vasoplegic syndrome in left ventricular assist device patients

The use of hydroxocobalamin for vasoplegic syndrome in left ventricular assist device patients

Treatment of refractory shock with vitamin B12: A narrative review

Clinical approach to vasoplegia in the transplant patient from the Pediatric Heart Transplant Society

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Treatment of refractory shock with vitamin B₁₂: A narrative review