Synthetic Human Angiotensin II for Post-Cardiopulmonary Bypass Vasoplegic Shock

Abstract Salvage therapies for vasoplegic shock following cardiopulmonary bypass refractory to intravenous vasopressors are limited, yet urgently needed. Angiotensin II is a recently approved, synthetic analogue of the human peptide with direct vasoconstrictive actions on vascular smooth muscle cells increasing systemic blood pressure independent of adrenergic receptors. We report a case series of four patients with vasopressor-refractory high-output vasoplegic shock following cardiothoracic surgical procedures requiring cardiopulmonary bypass treated with intravenous synthetic human angiotensin II. These cases included a heart transplantation, aortic valve replacement, bilateral lung transplantation, and left ventricular assist device implantation. All cases remained vasodilated despite epinephrine, vasopressin, and escalating dosages of norepinephrine. Following angiotensin II administration, we observed improved hemodynamics and reductions of vasopressor doses. No adverse effects attributed to angiotensin II administration were noted. Angiotensin II is a potential pharmacotherapeutic option for vasopressor-refractory post-cardiopulmonary bypass vasoplegic shock that warrants further investigation.