Cardiac performance during vasopressin infusion in postcardiotomy shock.
OBJECTIVE
Arginine-vasopressin (AVP) might be a potent vasopressor agent in catecholamine-resistant postcardiotomy shock. However, its use remains experimental because of considerations about deleterious effects on the heart. We report on the effects of continuous AVP-infusion on cardiac performance, biomarkers of myocardial ischemia, and systemic hemodynamics in catecholamine-resistant postcardiotomy shock.


METHODS
Retrospective study.


METHODS
Twenty-one-bed general and surgical intensive care unit.


METHODS
Forty-one patients with catecholamine-resistant postcardiotomy shock.


METHODS
Continuous infusion of AVP.


RESULTS
Heart rate (HR), heart rhythm, mean arterial pressure (MAP), central venous pressure, mean pulmonary arterial pressure, cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI), systemic vascular resistance (SVR) as well as milrinone and norepinephrine requirements were collected before and 1, 4, 12, 24, and 48 h after start of AVP infusion. Creatine kinase MB and troponin-I serum concentrations were measured daily. During AVP administration we observed a significant decrease in HR (-14.8%), milrinone (-17.5%), and norepinephrine requirements (-54.9%) as well as biomarkers of cardiac ischemia and a significant increase in LVSWI (+46.2%), MAP (+41.8%) and SVR (+60%). CI and SVI remained unchanged. Forty-five percent of postoperative new-onset tachyarrhythmias (TA) converted into sinus rhythm during AVP infusion.


CONCLUSIONS
AVP was devoid of adverse effects on the heart in these patients with catecholamine-resistant postcardiotomy shock. The significant reduction in HR, vasopressor, and inotropic support suggest a substantial improvement in myocardial performance. These findings are supported by a significant decrease of cardiac enzymes and cardioversion of TA into sinus rhythm in 45.5% of patients with new-onset TA.
Dünser
M W
MW
Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Mayr
A J
AJ
Stallinger
A
A
Ulmer
H
H
Ritsch
N
N
Knotzer
H
H
Pajk
W
W
Mutz
N J
NJ
Hasibeder
W R
WR
D018806:APACHE; D000368:Aged; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012769:Shock / Q000188:drug therapy* / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin