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]
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.
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