Martin W Dünser1, Olivier Bouvet2, Hans Knotzer3, Nish Arulkumaran4, Ludhmila Abrahao Hajjar5, Hanno Ulmer6, Walter R Hasibeder7. 1. Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria. Electronic address: martin.duenser@i-med.ac.at. 2. Amomed Pharma GmbH, Vienna, Austria. 3. Department of Anesthesiology and Critical Care Medicine II, Klinikum Wels, Wels, Austria. 4. Department of Critical Care, University College of London Hospital, London, UK. 5. Department of Cardiopneumology, InCor, University of Sao Paulo, Sao Paulo, Brazil. 6. Institute of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria. 7. Department of Anesthesiology and Critical Care Medicine, Krankenhaus St. Vinzenz in Zams, Zams, Austria.
Abstract
OBJECTIVE: To summarize the results of randomized controlled trials on the use of vasopressin as a vasopressor agent in cardiac surgery. DESIGN: Meta-analysis. PARTICIPANTS: Six-hundred-twenty-five adult patients undergoing elective or emergency cardiac surgery. INTERVENTIONS: Arginine vasopressin infusion (n = 313) or control/standard therapy (n = 312). MEASUREMENTS AND MAIN RESULTS: The rates of perioperative complications and postoperative mortality were used as primary and secondary endpoints, respectively. Fixed and/or random effects models were used to compare pooled odds ratios. Arginine vasopressin reduced the pooled odds ratio (OR) of perioperative complications (OR, 0.33; 95% confidence interval [CI], 0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest trial showed an unchanged reduction in perioperative complications (OR, 0.35; 95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative complication separately, vasopressin reduced the pooled OR of vasodilatory shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of postoperative death was not different between patients treated with arginine vasopressin and those receiving standard therapy or placebo (OR, 0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary endpoint suggested a relevant publication bias. All included trials suffered from a high risk of bias. CONCLUSION: Our meta-analysis suggests that arginine vasopressin may reduce the rate of perioperative complications in patients undergoing elective or emergency cardiac surgery. No difference in postoperative mortality was observed. An adequately powered multicenter trial is required for reliable estimation of the effects of arginine vasopressin on perioperative complication rates and mortality in cardiac surgical patients.
OBJECTIVE: To summarize the results of randomized controlled trials on the use of vasopressin as a vasopressor agent in cardiac surgery. DESIGN: Meta-analysis. PARTICIPANTS: Six-hundred-twenty-five adult patients undergoing elective or emergency cardiac surgery. INTERVENTIONS: Arginine vasopressin infusion (n = 313) or control/standard therapy (n = 312). MEASUREMENTS AND MAIN RESULTS: The rates of perioperative complications and postoperative mortality were used as primary and secondary endpoints, respectively. Fixed and/or random effects models were used to compare pooled odds ratios. Arginine vasopressin reduced the pooled odds ratio (OR) of perioperative complications (OR, 0.33; 95% confidence interval [CI], 0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest trial showed an unchanged reduction in perioperative complications (OR, 0.35; 95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative complication separately, vasopressin reduced the pooled OR of vasodilatory shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of postoperative death was not different between patients treated with arginine vasopressin and those receiving standard therapy or placebo (OR, 0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary endpoint suggested a relevant publication bias. All included trials suffered from a high risk of bias. CONCLUSION: Our meta-analysis suggests that arginine vasopressin may reduce the rate of perioperative complications in patients undergoing elective or emergency cardiac surgery. No difference in postoperative mortality was observed. An adequately powered multicenter trial is required for reliable estimation of the effects of arginine vasopressin on perioperative complication rates and mortality in cardiac surgical patients.
Authors: Mahesh Ramanan; Shaun Roberts; James Patrick Adrian McCullough; Rishendran Naidoo; Ivan Rapchuk; Mbakise Matebele; Alexis Tabah; Peter Kruger; Julian Smith; Kiran Shekar Journal: Ann Card Anaesth Date: 2021 Oct-Dec
Authors: Emily A Vail; Meng-Shiou Shieh; Penelope S Pekow; Hayley B Gershengorn; Allan J Walkey; Peter K Lindenauer; Hannah Wunsch Journal: Ann Am Thorac Soc Date: 2021-01
Authors: D Pasero; A M Berton; G Motta; R Raffaldi; G Fornaro; A Costamagna; A Toscano; C Filippini; G Mengozzi; N Prencipe; M Zavattaro; F Settanni; E Ghigo; L Brazzi; A S Benso Journal: J Endocrinol Invest Date: 2020-11-27 Impact factor: 4.256