Targeting the contributors to vasorelaxation during vasoplegia from cardiopulmonary bypass.

Vasoplegia, a syndrome of noncardiogenic, non-hypovolaemic vasodilatory hypotension is a common complication of cardiac surgery utilising cardiopulmonary bypass. Vasopressor-sparing strategies have been increasingly used in the management of vasoplegia to minimise the untoward ischaemic and arrhythmogenic effects of vasoconstrictors. A recent study found that hydroxocobalamin, a non-vasoconstricting modulator of nitric oxide pathways, provided a clinically meaningful vasopressor-sparing effect in the first 24 h of vasoplegia.

Norepinephrine pharmacolexicology: a chronological review of dose reporting and the implications of salt formulations.

Uncertainties in norepinephrine dose reporting due to variable labeling practices secondary to salt formulation considerations have resulted in significant clinical and research challenges, potentially leading to impaired comparability across studies. The objective of this review was to summarize the chronology of the available literature on the issue of norepinephrine salt formulations and dose reporting. A systematic search of PubMed/MEDLINE, EMBASE, and Google Scholar databases was conducted to identify pertinent studies addressing the variability in norepinephrine salt formulations and labeling practices, the evolution of pharmacological understanding, and recent developments in proposed guidelines.

Dosing Reliability of Direct Thrombin Inhibitors in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.

Empirical evidence suggests direct thrombin inhibitors (DTIs) produce more favorable hemostatic outcomes than heparin in patients supported by extracorporeal membrane oxygenation (ECMO), yet the exact mechanisms responsible are unknown. We systematically searched databases and registers for studies comparing DTIs to heparin in humans receiving ECMO. A total of 28 studies were identified, most of which (n = 25) used bivalirudin, while the rest (n = 3) used argatroban.

Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study.

Background: Ascorbic acid is an essential cofactor of catecholamine synthesis that increases capillary bed density and improves microcirculation perfusion. We hypothesized early ascorbic acid administration in cardiothoracic surgery would preserve the microcirculatory integrity and minimize postoperative vasoplegia.

Methods: This was a single-arm pilot feasibility study of adults undergoing septal myectomy combined with valve intervention or alone using cardiopulmonary bypass.

Analysis of 2024 EACTS/EACTAIC/EBCP Guidelines on Cardiopulmonary Bypass in Adult Cardiac Surgery.

Cardiopulmonary bypass (CPB) in cardiac surgery involves the integration of multidisciplinary expertise, requiring collaboration among clinical perfusionists, surgeons, anesthesiologists, intensivists, and patients. This updated guideline, developed by the European Association for Cardio-Thoracic Surgery, the European Association for Cardiothoracic Anesthesia and Intensive Care, and the European Board of Cardiovascular Perfusion, incorporates the latest evidence to offer evidence-based recommendations for CPB. It expands on previous guidelines by addressing a broader range of CPB-related factors that impact patient outcomes.

An index of the initial blood pressure response to angiotensin II treatment and its association with clinical outcomes in vasodilatory shock.

Background: No standardized index exists to assess cardiovascular responsiveness to angiotensin-II. We hypothesized that a standardized index of initial blood pressure response to angiotensin-II treatment would be associated with clinical outcomes.

Methods: Using data from the Angiotensin Therapy for High Output Shock (ATHOS-3) trial, we developed an Angiotensin-II Initial MAP Response Index of Treatment Effect (AIMRITE) defined as (MAP at hr1 - MAP at baseline)/study drug dose.

ADJUNCTIVE VASOPRESSORS AND SHORT-TERM MORTALITY IN ADULTS WITH SEPTIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Background: Adjunctive vasopressors are added to norepinephrine in one-third of adults with septic shock in the United States. However, effectiveness of this approach is unclear, and treatment recommendations are based on indirect evidence. We sought to synthesize the direct evidence for adjunctive vasopressor administration in adults with septic shock.

Anticoagulation during extracorporeal membrane oxygenation.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the efficacy and safety of anticoagulation for maintaining extracorporeal membrane oxygenation in people of all ages with cardiac or respiratory failure, or both.

Mechanical Circulatory Support for Acute Myocardial Infarction Cardiogenic Shock: Review and Recent Updates.

Cardiogenic shock (CS) in acute myocardial infarction (AMI) is a life-threatening syndrome characterized by systemic hypoperfusion that can quickly progress to multiorgan failure and death. Various devices and configurations of mechanical circulatory support (MCS) exist to support patients, each with unique pathophysiological characteristics. The Intra-aortic balloon pump can improve coronary perfusion, decrease afterload, and indirectly augment cardiac output.

Non-adrenergic vasopressors for vasodilatory shock or perioperative vasoplegia: a meta-analysis of randomized controlled trials.

Background: Excessive exposure to adrenergic vasopressors may be harmful. Non-adrenergic vasopressors may spare adrenergic agents and potentially improve outcomes. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of non-adrenergic vasopressors in adult patients receiving vasopressor therapy for vasodilatory shock or perioperative vasoplegia.

Oral blood pressure augmenting agents for intravenous vasopressor weaning.

Intravenous (IV) vasopressors are essential in the management of hypotension and shock. Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice. While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose, its adverse effect profile may preclude its use in certain populations.

Early high-dose vasopressors in refractory septic shock: A cohort study.

Purpose: Septic shock refractory to high-dose vasopressors confers unacceptably high mortality, however, the impact of timing of peak vasopressor dose exposure on outcomes is unknown.

Methods: This retrospective cohort study included adults who required a vasopressor dose ≥0.5 μg/kg/min norepinephrine-equivalents in the first 24 h of septic shock.

Analysis of The 2024 ESC/EACTS Guidelines For The Management Of Atrial Fibrillation.

The 2024 European Society of Cardiology guidelines for atrial fibrillation (AF) emphasize a patient-centered approach to management, structured around the AF-CARE pathway: Comorbidity and risk factor management (C), Avoiding stroke and thromboembolism (A), Reducing symptoms through rate and rhythm control (R), and Evaluation and dynamic reassessment (E). This framework ensures that comorbidities such as hypertension, heart failure, diabetes, and obesity are effectively managed to prevent disease progression and improve outcomes. A key principle of the guidelines is shared decision making involving patients, families, caregivers, and healthcare teams to ensure individualized care that reflects patient preferences.

Challenges in renally eliminated medication use: Evaluating cystatin C and serum creatinine eGFR discordance.

Background: Accurately estimating glomerular filtration rate (GFR) is crucial for dosing medications in hospitalized patients. Due to limitations of serum creatinine for GFR estimation, serum cystatin C (CysC) has been explored as an alternative functional kidney biomarker. This study assessed discordance between eGFR and eGFR in a large sample of hospitalized patients and examined the frequency of renally eliminated medications affected by eGFR discordance.

The renin-angiotensin-aldosterone-system in sepsis and its clinical modulation with exogenous angiotensin II.

Dysregulation of the renin-angiotensin-aldosterone-system (RAAS) in sepsis is a complex and early phenomenon with a likely significant contribution to organ failure and patient outcomes. A better understanding of the pathophysiology and intricacies of the RAAS in septic shock has led to the use of exogenous angiotensin II as a new therapeutic agent. In this review, we report a multinational and multi-disciplinary expert panel discussion on the role and implications of RAAS modulation in sepsis and the use of exogenous angiotensin II.

Remimazolam in Cardiac Anesthesia: Analysis of Recent Data.

Interest in remimazolam has surged in recent years, thanks to its advantageous pharmacologic profile. This ultra-short-acting benzodiazepine is noted for its rapid onset and termination of action, organ-independent elimination, availability of a reversal agent, and excellent hemodynamic stability. Although the use of remimazolam has been explored in various anesthesia settings and procedures, data on its application in cardiovascular anesthesia and catheterization laboratory procedures remain limited.

Bivalirudin in Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a mechanical support treatment modality used in patients with refractory cardiac and/or pulmonary failure. Bleeding and thrombotic complications associated with ECMO are inherent concerns that require careful management. Anticoagulation optimization may help mitigate these risks by providing more adequate therapeutic anticoagulation and lessen the bleed risk.