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 in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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