Cardiothoracic & vascular anesthesia
Epidemiology, risk factors and outcomes of norepinephrine use in cardiac surgery with cardiopulmonary bypass: a multicentric prospective study
Authors' conclusion
Norepinephrine is often used in cardiac surgical patients but for <24 h with a low dose. Many preoperative and surgical factors are associated with norepinephrine use. Patients supported by norepinephrine have a higher incidence of major postoperative events.
Study context
- Population
- Patients undergoing cardiac surgery with CPB (excluding pre-ECMO surgery, LVAD implantation, heart transplantation and intra-operative hemorrhage)2,510 analysed
- Participants
- 2,862 patients
- Exposure
- Norepinephrine use vs no norepinephrine use
- Norepinephrinen = 1,549
- Outcome
- Prevalence of norepinephrine use
Methodological detailsmulticentre, 4 university-affiliated cardiovascular units
- Multicentre
- 4 university-affiliated cardiovascular units
Main finding
As reported in the abstract
Norepinephrine
61%
1549
Observational data: associations, not effects.
Further findings
- Maximal norepinephrine dose
- 0.11 · median · range 0.06–0.2 · μg.kg-1.min-1
- Duration of norepinephrine
- 10 · median · range 2–24 · h
Timing of norepinephrine start
- Most often started in the operating room before CPB
Factors associated with norepinephrine use (multiple logistic regression)
- Modifiable: haematocrit, maintenance of beta-blocker, CPB time, glucose-insulin-potassium, Custodiol cardioplegia, Delnido cardioplegia, fibrinogen transfusion
- Non-modifiable: age, ASA score, chronic high BP, coronary disease, dyslipidemia, right ventricular dysfunction, left ventricular dysfunction, active endocarditis, valvular aortic surgery
Mortality, morbidity (neurological and renal complications, death) and ICU LOS
- Higher in patients treated with norepinephrine
Original publication
Epidemiology, risk factors and outcomes of norepinephrine use in cardiac surgery with cardiopulmonary bypass: a multicentric prospective study. Anaesth Crit Care Pain Med. Published 8 February 2023. doi:10.
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