Cyanokit Hydroxocobalamin: A Safe and Effective Rescue Therapy for Refractory Vasoplegic Shock

Vasoplegia, a condition characterized by low mean arterial pressure, is a common complication following cardiac surgery. Despite the use of various vasoactive drugs, refractory vasopressors often fail to maintain target blood pressure, leading to poor outcomes in patients not responsive to first-line therapy. In this article, we discuss our experience with using high-dose hydroxocobalamin as a rescue therapy for refractory vasoplegic shock following cardiac surgery.

Vasoplegia is defined by low mean arterial pressure, typically below 2.2L/kg/m2. Predisposing factors include preoperative antihypertensive use, low preoperative left ventricular ejection fraction, recent myocardial infarction, and diabetes mellitus. The condition affects 5-25% of patients during or following cardiopulmonary bypass (CPB), with an incidence as high as 50% in patients with predisposing risk factors.

Our observational study describes the use of high-dose hydroxocobalamin as a rescue therapy for refractory vasoplegic shock post CPB. In seven patients, administration of hydroxocobalamin 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. Notably, no deaths or adverse effects attributable to hydroxocobalamin administration occurred in our cohort.

Hydroxocobalamin, also known as vitamin B12, is an emerging targeted rescue therapy for the treatment of refractory vasoplegic shock. Our findings support its use as a safe and effective alternative to traditional catecholamine vasopressors in managing this life-threatening condition following cardiac surgery.

In conclusion, high-dose hydroxocobalamin offers promise as a rescue therapy for refractory vasoplegic shock post CPB. Further research is needed to fully understand its mechanisms of action and optimal dosing regimens, but our data suggest that it may be a valuable addition to the armamentarium of treatment options for this devastating condition.

Cyanokit hydroxocobalamin