Cardiothoracic & vascular anesthesia
Evaluating the Impact of a Standardized Protocol for Managing Refractory Vasoplegia After Cardiopulmonary Bypass
Main finding · Rate of decline in percentage change in NEeqResult — go to the resultSteeper rate of decline −2.01 % NEeq per 15-minute intervalAuthors' conclusion
Implementation of a stepwise protocol using MB, angiotensin II, and hydroxocobalamin for refractory vasoplegia resulted in significant cost savings, hastened NEeq reduction, and similar short-term clinical outcomes.
Study context
- Population
- Cardiothoracic surgery patients requiring cardiopulmonary bypass (CPB) who received at least one rescue agent (angiotensin II, hydroxocobalamin or MB) perioperatively for refractory vasoplegia (≥0.25 μg/kg/min norepinephrine equivalents (NEeq))
- Participants
- 215 patients
- Exposure
- Post-protocol vs Pre-protocol
- Post-protocoln = 96
- Pre-protocoln = 119reference
- Outcome
- Rate of decline in percentage change in NEeq
- Follow-up
- Initial 3 hours
Methodological detailssingle-centre, academic teaching hospital
- Single-centre
- Academic teaching hospital
Main finding
As reported in the abstract
Steeper rate of decline
−2.01 % NEeq per 15-minute interval
P < 0.01
Observational data: associations, not effects.
Further findings
Mean NEeq requirement before rescue agent
- No difference in mean NEeq requirement preceding rescue agent administration (pre- vs post-protocol, as printed)
- 0.32 μg/kg/min v 0.31 μg/kg/min
Cost of vasoactive agents (Post-protocol vs Pre-protocol) · 24 hours
- Average cost reduction
- 30%
- p < 0.01
Cost of vasoactive agents (Post-protocol vs Pre-protocol) · 48 hours
- Average cost reduction
- 26%
- p < 0.01
Short-term clinical outcomes
- No differences between groups
Original publication
Evaluating the Impact of a Standardized Protocol for Managing Refractory Vasoplegia After Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. Published 6 February 2026. doi:10.
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