Cardiothoracic & vascular anesthesia
Hydroxocobalamin Versus Methylene Blue for Treatment of Vasoplegic Shock Following Cardiopulmonary Bypass: A Systematic Review and Meta-analysis
Authors' conclusion
Hydroxocobalamin has been shown to have a beneficial effect on hemodynamics and vasopressor requirements in vasoplegic cardiac surgery patients compared with methylene blue, although evidence is limited
Study context
- Population
- Adult cardiac surgery patients with vasoplegic shock after CPB
- Participants
- 263 patients · 4 retrospective observational studies
- Comparison
- Hydroxocobalamin vs methylene blue
- Outcome
- Vasopressor requirement (mcg/kg/min norepinephrine equivalent [NEE])
- Follow-up
- 1 hour
Methodological detailsmulti-institutional, Three studies at moderate risk of bias and one at serious risk
- Multi-institutional
- Three studies at moderate risk of bias and one at serious risk
Pooled result
As reported in the abstract
Vasopressor requirement at 1 h (primary outcome)
No significant difference in vasopressor requirement at 1 h, MD (mcg/kg/min NEE)
0.00
95% CI of the MD
−0.09 to 0.08
Further pooled results
| Outcome | MD (mmHg) (95% CI) | |
|---|---|---|
| MAP · 1 hour | 5.30 (2.98–7.62) | |
| −50510Difference, mmHg (linear scale) |
| Outcome | MD (mcg/kg/min NEE) (95% CI) | |
|---|---|---|
| Total vasopressor dose · 1 hour | −0.13 (−0.25 to −0.01) | |
| Total vasopressor · 6 hours | −0.15 (−0.21 to −0.08) | |
| −0.3−0.2−0.100.1Difference, mcg/kg/min NEE (linear scale) |
Systemic vascular resistance and mortality
- No differences between groups
Original publication
Hydroxocobalamin Versus Methylene Blue for Treatment of Vasoplegic Shock Following Cardiopulmonary Bypass: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth. Published 5 October 2024. doi:10.
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