Hydroxocobalamin for Vasoplegia in Cardiac Surgery: A Retrospective Cohort Analysis

Authors

• Luai Zakaria
• Karan Shah
• Dongsheng Yang
• Marta Kelava
• Haytham Elgharably
• Ashish K Khanna
• Sanchit Ahuja
• Benjamin Hohlfelder
• Andrej Alfirevic
• Andra E Duncan
• Nikolaos J Skubas
• Daniel I Sessler

Language

English

Publication Date

10-1-2025

Journal

British Journal of Anaesthesia

DOI

10.1016/j.bja.2025.05.026

PMID

40634185

PMCID

PMC12674016

Abstract

Background: Vasoplegia during cardiac surgery is common and associated with perioperative mortality. Hydroxocobalamin is a catecholamine-sparing approach for treating vasoplegia. However, there is currently limited evidence to inform its use.

Methods: We conducted a single-centre retrospective propensity-matched cohort study of patients who developed vasoplegia after cardiopulmonary bypass. Our primary outcome was vasopressor requirement, expressed as norepinephrine equivalents (NEE), at 1, 4, 24, and 48 h after treatment. Our secondary outcome was a collapsed composite of in-hospital complications comprising stroke, sternal wound infection, mesenteric ischaemia, renal failure, and death.

Results: We identified 2727 (11%) patients with vasoplegia from 2018 to 2024. The final analysis cohort included 229 matched pairs. Hydroxocobalamin administration was associated with a significant reduction in median NEE infusion rates of -0.04 (95% confidence interval [CI]: -0.07 to -0.02; P=0.008) μg kg-1 min-1 at 1 h, -0.05 (95% CI: -0.07 to -0.02; P< 0.001) μg kg-1 min-1 at 4 h, and -0.04 (95% CI: -0.06 to -0.02; P=0.004) μg kg-1 min-1 at 24 h, but not at 48 h, -0.02 (95% CI: -0.05 to 0.0; P=0.220) μg kg-1 min-1. Over the initial 24 h, hydroxocobalamin reduced NEE by 14% compared with the reference group. The risk of in-hospital complications was similar in each group (odds ratio: 1.06; 95% CI: 0.74-1.54; P=0.745).

Conclusions: Hydroxocobalamin administration was associated with reduced vasopressor requirement over 24 h, but not thereafter. Robust trials are needed to determine whether this relationship is causal, and whether a reduction in vasopressor use improves substantive clinical outcomes.

Keywords

Humans, Vasoplegia, Retrospective Studies, Male, Female, Aged, Hydroxocobalamin, Cardiac Surgical Procedures, Middle Aged, Vasoconstrictor Agents, Cohort Studies, Cardiopulmonary Bypass, Postoperative Complications, cardiac surgery, cardiopulmonary bypass, hydroxocobalamin, vasoplegia, vasopressor

Published Open-Access

yes

Recommended Citation

Zakaria, Luai; Shah, Karan; Yang, Dongsheng; et al., "Hydroxocobalamin for Vasoplegia in Cardiac Surgery: A Retrospective Cohort Analysis" (2025). Faculty, Staff and Student Publications. 1541.
https://digitalcommons.library.tmc.edu/uthsph_docs/1541