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. 2022 Aug 22;14(8):e28267.
doi: 10.7759/cureus.28267. eCollection 2022 Aug.

High-Dose Hydroxocobalamin for Refractory Vasoplegia Post Cardiac Surgery

Marek A Bak  1 , Julian A Smith  1 , Brendan Murfin  2 , Yi Chen  1
Affiliations

High-Dose Hydroxocobalamin for Refractory Vasoplegia Post Cardiac Surgery

Marek A Bak et al. Cureus. .

Abstract

Administration of high-dose hydroxocobalamin, or vitamin B12, is an emerging, targeted rescue therapy for the treatment of refractory vasoplegic shock. This is an uncommon but potentially life-threatening complication following cardiac surgery and carries a poor prognosis, particularly when patients fail to respond to first-line therapy with catecholamine vasopressors. This study describes our experience in treating refractory vasodilatory shock following cardiac surgery with high-dose hydroxocobalamin. Administration of hydroxocobalamin in seven patients was associated with an improvement in mean arterial blood pressure or reduction in vasopressor requirements, which were both immediate and sustained throughout our observational period. No deaths or adverse effects attributable to hydroxocobalamin administration occurred in our cohort. Our observations show that high-dose hydroxocobalamin is a safe and effective rescue therapy in refractory vasoplegic shock post cardiopulmonary bypass (CPB).

Keywords: cardiopulmonary bypass; critical care; hydroxocobalamin; vasoplegia; vitamin b12.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Changes in MAP following B12 administration.
MAP: Mean arterial pressure.
Figure 2
Figure 2. Changes in vasopressor requirements following B12 administration.
NAE: Noradrenaline-equivalents.
See this image and copyright information in PMC

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