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Ann Thorac Surg 2003;75:926-930
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

A double-blind randomized trial: prophylactic vasopressin reduces hypotension after cardiopulmonary bypass

David L.S. Morales, MD*a, Mauricio J. Garrido, MDa, John D. Madigan, BAa, David N. Helman, MDa, Joseph Faber, BAa, Mathew R. Williams, MDa, Donald W. Landry, MD, PhDb, Mehmet C. Oz, MDa

a Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA
b Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA

Accepted for publication September 5, 2002.

* Address reprint requests to Dr Morales, Department of Surgery, MHB 7-435, 177 Fort Washington Ave, New York, NY 10032, USA
e-mail: dlm36{at}columbia.edu

BACKGROUND: Inhibition of angiotensin-converting enzyme (ACE) predisposes patients to vasodilatory hypotension after cardiopulmonary bypass (CPB). This hypotension has been correlated with arginine vasopressin deficiency and can be corrected by its replacement. In patients receiving ACE inhibition, we investigated whether initiation of vasopressin before CPB would diminish post-CPB hypotension and catecholamine use by avoiding vasopressin deficiency.

METHODS: Cardiac surgical patients on ACE inhibitor therapy were randomized to receive vasopressin (0.03 U/min) (n = 13) or an equal volume of normal saline (n = 14) starting 20 minutes before CPB.

RESULTS: Vasopressin did not change pre-CPB mean arterial pressure or pulmonary artery pressure. After CPB, the vasopressin group had a lower peak norepinephrine dose than the placebo group (4.6 ± 2.5 versus 7.3 ± 3.5 µg/min, p = 0.03), a shorter period on catecholamines (5 ± 6 versus 11 ± 7 hours, p = 0.03), fewer hypotensive episodes (1 ± 1 versus 4 ± 2, p < 0.01), and a shorter intensive care unit length of stay (1.2 ± 0.4 versus 2.1 ± 1.4 days, p = 0.03).

CONCLUSIONS: In this cohort, prophylactic administration of vasopressin, at a dose without a vasopressor effect pre-CPB, reduced post-CPB hypotension and vasoconstrictor requirements, and was associated with a shorter intensive care unit stay.




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