A prospective randomized trial of arginine vasopressin in the treatment of vasodilatory shock after left ventricular assist device placement.
BACKGROUND
Vasodilatory shock requiring catecholamine pressors occurs in some patients following cardiopulmonary bypass. Prompted by a clinical observation, we investigated the use of vasopressin as a treatment for this syndrome in a randomized, controlled trial.


RESULTS
Patients undergoing placement of a left ventricular assist device (n=23) were evaluated for post-bypass vasodilatory shock requiring catecholamine pressors, and consecutive eligible subjects (n=10) were evenly randomized to blinded intravenous vasopressin or saline placebo. Vasopressin (0.1 U/min) increased mean arterial pressure (57+/-4 to 84+/-2 mm Hg, P<.001) and systemic vascular resistance (813+/-113 to 1188+/-87 dyne-s/cm5, P<.001), with decreased norepinephrine administration. There was no significant response to saline, but in three subjects who crossed over, blinded vasopressin increased mean arterial pressure (69+/-8 to 93+/-4 mm Hg) and systemic vascular resistance (898+/-88 to 1443+/-72 dyne-s/cm5) with decreased norepinephrine administration. Plasma vasopressin concentrations prior to randomization clustered in two groups: one (n=5) with concentrations inappropriately low for the degree of hypotension (8.4+/-2.1 pg/mL) and a second (n=3) with moderately elevated levels (33.7+/-1.6 pg/mL); vasopressin increased mean arterial pressure in the low vasopressin group from 57+/-4 to 85+/-2 mm Hg (P<.01) and in the high vasopressin group from 68+/-8 to 86+/-4 mm Hg.


CONCLUSIONS
Vasopressin is an effective pressor in vasodilatory shock after cardiopulmonary bypass. An absolute vasopressin deficiency was observed in the majority of patients, but all subjects responded to vasopressin administration.
Argenziano
M
M
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Choudhri
A F
AF
Oz
M C
MC
Rose
E A
EA
Smith
C R
CR
Landry
D W
DW
D001127:Arginine Vasopressin / Q000097:blood / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012769:Shock / Q000188:drug therapy*; D014664:Vasodilation / Q000187:drug effects
D001127:Arginine Vasopressin