Definitions for Vasoplegia Associated With On-Pump Cardiac Surgery: A Systematic Review With Meta-Analysis

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Vasoplegia is a frequent and serious complication following cardiopulmonary bypass in cardiac surgery.
• Current diagnostic criteria for vasoplegia are inconsistent, hindering accurate incidence estimation and comparative analysis.
• This variability contributes to significant patient morbidity and mortality.

Purpose of the Study:

• To evaluate the diverse diagnostic criteria and definitions used for vasoplegia in cardiac surgery.
• To assess how variations in these definitions impact the reported incidence of vasoplegia.
• To highlight the need for a standardized definition of vasoplegia.

Main Methods:

• A systematic literature search was conducted across multiple databases (Embase, MEDLINE, Scopus, Web of Science, etc.) and clinical trial registries.
• Included studies were randomized clinical trials and observational studies involving adults undergoing cardiac surgery with cardiopulmonary bypass.
• A proportional meta-analysis using a random-effects model was employed to calculate pooled incidence rates.

Main Results:

• 68 studies involving 56,580 patients were analyzed, revealing 63 distinct definitions of vasoplegia.
• Common criteria included blood pressure (84%) and cardiac output (74%), but with highly variable threshold values.
• The pooled incidence of vasoplegia was 21%, with associated acute kidney injury at 32% and mortality at 12%.

Conclusions:

• Significant heterogeneity exists in the published definitions of vasoplegia after on-pump cardiac surgery.
• The lack of a consensus definition complicates research and clinical practice.
• Establishing a unified, international definition for vasoplegia is an urgent priority.