Angiotensin II Use in Postcardiac Surgery Vasoplegic Syndrome Patients: A Single-Center Descriptive Experience

Abstract

Objectives: We evaluated real world use of angiotensin II (AT II) in patients with vasoplegic syndrome (VS) following cardiac surgery.

Design: A retrospective chart review was performed to describe and evaluate VS following cardiac surgery under cardiopulmonary bypass (CPB) for AT II use and associated outcomes. Among these outcomes examined were death, stroke, myocardial infarction, acute kidney injury (AKI), tracheostomy need, ventilator hours, and hospital and cardiovascular intensive care unit (CVICU) lengths of stay (LOS). These outcomes were compared across patients with VS who received AT II vs. patients who did not receive AT II using Wilcoxon rank sum and Chi-square testing, as appropriate.

Setting: Academic medical center.

Participants: Adult postcardiac surgery VS patients.

Interventions: AT II vs. non-AT II receiving VS patients.

Measurements and Main Results: Of 2013 included patients undergoing cardiac surgery under CPB during the study period, 52 met criteria for VS, 11 (21.2%) received AT II, and 41 (71.8%) did not. The incidence of AKI, tracheostomy, CVICU LOS, and hospital LOS was higher in the AT II group (Tables 1 and 2). The median maximum postoperative NEE dose within 24 h following surgery was higher in the AT II group: 0.44 mcg/kg/min (IQR 0.39, 0.57) versus 0.23 mcg/kg/min (IQR 0.21, 0.26, p < 0.001).

Conclusions: AT II use was rare among cardiac surgical patients. AT II use was associated with increased resource use. AT II patients were on higher pressure dosing and may have had worse outcomes without AT II. Larger, prospective studies are needed to understand the impact of AT II on outcomes in this population.