Key result
Angiotensin II is effective in raising blood pressure in patients with post-operative vasoplegia following cardiopulmonary bypass, without major adverse events reported.
Why the study?
Vasoplegia after cardiopulmonary bypass lacks treatment consensus, and outside the ATHOS-3 trial, data on angiotensin II for post-CPB vasoplegia have mainly been limited to case reports.
Does angiotensin II improve blood pressure in patients with post-cardiopulmonary bypass vasoplegia?
Systematic Review
Does angiotensin II improve blood pressure in patients with post-cardiopulmonary bypass vasoplegia?
Angiotensin II appears to be a promising and effective treatment for raising blood pressure in patients with refractory post-cardiopulmonary bypass vasoplegia, though large-scale evidence remains limited.
Supports incorporating angiotensin II for post-CPB vasoplegia; extends randomized evidence from septic shock to cardiac surgery.
PURPOSE: Vasoplegia is a common complication after cardiac surgery and is related to the use of cardiopulmonary bypass (CPB). Despite its association with increased morbidity and mortality, no consensus exists in terms of its treatment. In December 2017, angiotensin II (AII) was approved by the Food and Drug Administration (FDA) for use in vasodilatory shock; however, except for the ATHOS-3 trial, its use in vasoplegic patients that underwent cardiac surgery on CPB has mainly been reported in case reports. Thus, the aim of this review is to collect all the clinically relevant data and describe the pharmacologic mechanism, efficacy, and safety of this novel pharmacologic agent for the treatment of refractory vasoplegia in this population. METHODS: Two independent reviewers performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library using relevant MeSH terms (Angiotensin II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures). RESULTS: The literature search yielded 820 unique articles. In total, 9 studies were included. Of those, 2 were randomized clinical trials (RCTs) and 6 were case reports and 1 was a retrospective cohort study. CONCLUSIONS: AII appears to be a promising means of treatment for patients with post-operative vasoplegia. It is demonstrated to be effective in raising blood pressure, while no major adverse events have been reported. It remains uncertain whether this agent will be broadly available and whether it will be more advantageous in the clinical management of vasoplegia compared to other available vasopressors. For that reason, we should contain our eagerness and enthusiasm regarding its use until supplementary knowledge becomes available.
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Papazisi et al. (2020) conducted a systematic review in Post-cardiopulmonary Bypass Vasoplegia. Angiotensin II vs. Standard vasopressors or placebo was evaluated on Blood pressure response. Angiotensin II is effective in raising blood pressure in patients with post-operative vasoplegia following cardiopulmonary bypass, without major adverse events reported.
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