Vasoplegia Post Cardiopulmonary Bypass

Reviewed and revised 11 December 2014

OVERVIEW

  • vasoplegia after cardiopulmonary bypass is common
  • results from a bypass-induced SIRS response, but other causes of vasodilation (e.g. drugs, sepsis) can also contribute

CLINICAL FEATURES

  • haemodynamics:
    • hyperdynamic circulation with relatively high cardiac output
    • low SVR due to vasodilation
  • usually resolves within ~8 hours

RISK FACTORS

  • ACE-I
  • heparin use

MANAGEMENT

  • rule out other types of shock: tamponade, hypovolaemia, cardiogenic
  • rule out/ treat other causes of vasodilation
    • minimize vasodilators (milrinone, dobutamine)
    • treat sepsis if suspected
  • vasporessors
    • noradrenaline often used first line
    • vasopressin
    • methylene blue (2mg/kg) described as producing dramatic resolution

References and Links

  • Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002 Jul;97(1):215-52. PMID: 12131125. [Free Full Text]

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.