Treatment With Angiotensin II Is Associated With Rapid Blood Pressure Response and Vasopressor Sparing in Patients With Vasoplegia After Cardiac Surgery: A Post-Hoc Analysis of Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) Study
| Autor: | Adam S. Evans, Stew Kroll, Rakshit Panwar, Ara Klijian, Charles R. Greenfeld, Jamel Ortoleva, Bruce Friedman, Subhasis Chatterjee, Ashish Khanna, V. Seenu Reddy |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Mean arterial pressure
medicine.medical_specialty Blood Pressure 030204 cardiovascular system & hematology Placebo law.invention 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology law Vasoplegia Cardiopulmonary bypass medicine Humans Vasoconstrictor Agents Cardiac Surgical Procedures Cardiopulmonary Bypass business.industry Angiotensin II Cardiac surgery Anesthesiology and Pain Medicine Blood pressure Anesthesia Shock (circulatory) medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of cardiothoracic and vascular anesthesia. 35(1) |
| ISSN: | 1532-8422 |
| Popis: | Objective: The present study investigated outcomes in patients with vasoplegia after cardiac surgery treated with angiotensin II plus standard-of-care vasopressors. Vasoplegia is a common complication in cardiac surgery with cardiopulmonary bypass and is associated with significant morbidity and mortality. Approximately 250,000 cardiac surgeries with cardiopulmonary bypass are performed in the United States annually, with vasoplegia occurring in 20%to-27% of patients. Design: Post-hoc analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study. Setting: Multicenter, multinational study. Participants: Sixteen patients with vasoplegia after cardiac surgery with cardiopulmonary bypass were enrolled. Interventions: Angiotensin II plus standard-of-care vasopressors (n = 9) compared with placebo plus standard-of-care vasopressors (n = 7). Measurements and Main Results: The primary endpoint was mean arterial pressure response (mean arterial pressure ≥75 mmHg or an increase from baseline of ≥10 mmHg at hour 3 without an increase in the dose of standard-of-care vasopressors). Vasopressor sparing and safety also were assessed. Mean arterial pressure response was achieved in 8 (88.9%) patients in the angiotensin II group compared with 0 (0%) patients in the placebo group (p = 0.0021). At hour 12, the median standard-of-care vasopressor dose had decreased from baseline by 76.5% in the angiotensin II group compared with an increase of 7.8% in the placebo group (p = 0.0013). No venous or arterial thrombotic events were reported. Conclusion: Patients with vasoplegia after cardiac surgery with cardiopulmonary bypass rapidly responded to angiotensin II, permitting significant vasopressor sparing. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect