Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial
Ludhmila Abrahao Hajjar, Jean Louis Vincent, Filomena Regina Barbosa Gomes Galas, Andrew Rhodes, Giovanni Landoni, Eduardo Atsushi Osawa, Renato Rosa Melo, Marcia Rodrigues Sundin, Solimar Miranda Grande, Fabio A Gaiotto, Pablo Maria Pomerantzeff, Luis Oliveira Dallan, Rafael Alves Franco, Rosana Ely Nakamura, Luiz Augusto Lisboa, Juliano Pinheiro de Almeida, Aline Muller Gerent, Dayenne Hianae Souza, Maria Alice Gaiane, Julia Tizue Fukushima, Clarice Lee Park, Cristiane Zambolim, Graziela Santos Rocha Ferreira, Tânia Mara Strabelli, Felipe Lourenco Fernandes, Ligia Camara, Suely Zeferino, Valter Garcia Santos, Marilde Albuquerque Piccioni, Fabio Biscegli Jatene, Jose Otavio Costa Auler Jr, Roberto Kalil Filho, Ludhmila Abrahao Hajjar, Jean Louis Vincent, Filomena Regina Barbosa Gomes Galas, Andrew Rhodes, Giovanni Landoni, Eduardo Atsushi Osawa, Renato Rosa Melo, Marcia Rodrigues Sundin, Solimar Miranda Grande, Fabio A Gaiotto, Pablo Maria Pomerantzeff, Luis Oliveira Dallan, Rafael Alves Franco, Rosana Ely Nakamura, Luiz Augusto Lisboa, Juliano Pinheiro de Almeida, Aline Muller Gerent, Dayenne Hianae Souza, Maria Alice Gaiane, Julia Tizue Fukushima, Clarice Lee Park, Cristiane Zambolim, Graziela Santos Rocha Ferreira, Tânia Mara Strabelli, Felipe Lourenco Fernandes, Ligia Camara, Suely Zeferino, Valter Garcia Santos, Marilde Albuquerque Piccioni, Fabio Biscegli Jatene, Jose Otavio Costa Auler Jr, Roberto Kalil Filho
Abstract
Background: Vasoplegic syndrome is a common complication after cardiac surgery and impacts negatively on patient outcomes. The objective of this study was to evaluate whether vasopressin is superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome.
Methods: This prospective, randomized, double-blind trial was conducted at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between January 2012 and March 2014. Patients with vasoplegic shock (defined as mean arterial pressure less than 65 mmHg resistant to fluid challenge and cardiac index greater than 2.2 l · min · m) after cardiac surgery were randomized to receive vasopressin (0.01 to 0.06 U/min) or norepinephrine (10 to 60 μg/min) to maintain arterial pressure. The primary endpoint was a composite of mortality or severe complications (stroke, requirement for mechanical ventilation for longer than 48 h, deep sternal wound infection, reoperation, or acute renal failure) within 30 days.
Results: A total of 330 patients were randomized, and 300 were infused with one of the study drugs (vasopressin, 149; norepinephrine, 151). The primary outcome occurred in 32% of the vasopressin patients and in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95% CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found a lower occurrence of atrial fibrillation in the vasopressin group (63.8% vs. 82.1%; P = 0.0004) and no difference between groups in the rates of digital ischemia, mesenteric ischemia, hyponatremia, and myocardial infarction.
Conclusions: The authors' results suggest that vasopressin can be used as a first-line vasopressor agent in postcardiac surgery vasoplegic shock and improves clinical outcomes.
Source: PubMed