Miles Travis J, Guinn Michael T, Suero Orlando R, Rosengart Todd K, Moon Marc R, Coselli Joseph S, Ghanta Ravi K, Chatterjee Subhasis
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Divisions of Cardiovascular Anesthesia & Critical Care Medicine, Department of Anesthesiology, Baylor College of Medicine, Houston, Tex.
JTCVS Open. 2025 Apr 25;25:280-293. doi: 10.1016/j.xjon.2025.04.014. eCollection 2025 Jun.
Vasoplegic shock after cardiopulmonary bypass (CPB) is a highly morbid condition. The novel vasopressor angiotensin II is increasingly being used for catecholamine-resistant vasoplegia. Although early intervention with adjunctive therapies such as methylene blue can improve outcomes of vasoplegia, the optimal timing for escalation with angiotensin II is unknown.
Pharmacologic data were extracted from electronic health records for patients who underwent surgery with CPB during 2017-2022. Patients were identified who received angiotensin II intraoperatively or postoperatively (ie, early or late). Multivariable logistic regression was used to determine the risk-adjusted effects of earlier angiotensin II administration on postoperative major adverse events: mortality and major morbidity.
Seventy (1.4%) patients received angiotensin II for vasoplegia. The median [interquartile range] vasopressor dose at time of angiotensin II initiation was 0.33 [0.26-0.48] norepinephrine equivalents. Vasoplegia requiring treatment with angiotensin II was associated with substantial mortality (42.9% vs 3.3%, < .001) and major morbidity (81.4% vs 20.3%, < .001). The 51.4% of patients who began receiving angiotensin II intraoperatively had less major morbidity (94.1% vs 69.4%, = .019) and a trend toward lower mortality (30.6% vs 55.9%, = .057) than patients who received it postoperatively. In multivariable logistic regression, intraoperative initiation was an independent predictor of fewer major adverse events (odds ratio, 0.037; 95% confidence interval, 0.004-0.393).
Morbidity and mortality rates are high in patients given angiotensin II for vasoplegia. Initiating this medication intraoperatively may improve outcomes, underscoring the importance of early intervention for patients at risk for vasoplegia after CPB.
体外循环（CPB）后血管麻痹性休克是一种高发病症。新型血管升压药血管紧张素II越来越多地用于治疗对儿茶酚胺耐药的血管麻痹。尽管早期采用亚甲蓝等辅助疗法进行干预可改善血管麻痹的治疗效果，但血管紧张素II升级治疗的最佳时机尚不清楚。
从2017年至2022年接受CPB手术患者的电子健康记录中提取药理学数据。确定术中或术后（即早期或晚期）接受血管紧张素II治疗的患者。采用多变量逻辑回归分析来确定早期给予血管紧张素II对术后主要不良事件（死亡率和严重并发症）的风险调整影响。
70例（1.4%）患者因血管麻痹接受血管紧张素II治疗。血管紧张素II开始使用时血管升压药剂量的中位数[四分位间距]为0.33[0.26 - 0.48]去甲肾上腺素当量。需要用血管紧张素II治疗的血管麻痹与较高的死亡率（42.9%对3.3%，P <.001）和严重并发症发生率（81.4%对20.3%，P <.001）相关。与术后接受血管紧张素II治疗的患者相比，术中开始接受该治疗的51.4%患者的严重并发症发生率较低（94.1%对69.4%，P = 0.019），且死亡率有降低趋势（30.6%对55.9%，P = 0.057）。在多变量逻辑回归分析中，术中开始使用血管紧张素II是主要不良事件较少的独立预测因素（比值比，0.037；95%置信区间，0.004 - 0.393）。
接受血管紧张素II治疗血管麻痹的患者发病率和死亡率较高。术中开始使用这种药物可能改善治疗效果，强调了对CPB后有血管麻痹风险患者进行早期干预的重要性。
