Vasopressor Therapy in Cardiac Surgery-An Experts' Consensus Statement

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Reduced systemic vascular resistance is common in cardiac surgery.
• Vasoplegic shock can occur as a side effect of anesthesia.
• Vasopressor therapy is crucial for managing these conditions.

Purpose of the Study:

• To provide evidence-based recommendations for vasopressor use in cardiac surgery.
• To guide clinicians in choosing appropriate vasopressors.
• To address knowledge gaps in vasopressor selection.

Main Methods:

• Expert panel convened to develop recommendations.
• Critical appraisal of literature using the GRADE system.
• Modified Delphi process for consensus building.

Main Results:

• Strong recommendation for norepinephrine and/or vasopressin to maintain perfusion.
• No recommendation for norepinephrine or vasopressin regarding ischemic risk.
• Strong recommendation against dopamine for post-cardiac surgery vasoplegic shock.
• Recommendation against methylene blue except as rescue therapy.
• Weak recommendation for early addition of a second vasopressor if monotherapy fails.
• Consideration for vasopressin as first-line or adjunct therapy in specific patient groups.

Conclusions:

• Norepinephrine and vasopressin are preferred vasopressors for cardiac surgery patients.
• Dopamine should be avoided in post-cardiac surgery vasoplegic shock.
• Methylene blue has limited application.
• Combination therapy and vasopressin use in specific scenarios are suggested.