• Nicholas Vollmer, Patrick M Wieruszewski, Nathaniel Martin, Troy Seelhammer, Erica Wittwer, Christoph Nabzdyk, Kristin Mara, and Scott D Nei.
• Department of Pharmacy, Mayo Clinic Hospital-Rochester, Rochester, MN. Electronic address: Vollmer.Nicholas@mayo.edu.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 2908-2916.

ObjectiveThe primary aim of this study was to identify predictors of response to hydroxocobalamin.DesignA retrospective cohort study.SettingA single large academic medical center within the cardiovascular surgery intensive care unit.ParticipantsPostoperative cardiovascular surgery patients within 96 hours of cardiopulmonary bypass separation between May 7, 2018, and August 1, 2020.InterventionsNone.Measurements And Main ResultsOf the 66 administrations, 43 administrations yielded hemodynamic improvements (65.2%). Comparing responders to nonresponders, nonresponders had a greater median cardiopulmonary bypass duration (223 v 131 minutes; p < 0.001) and a prolonged median cross-clamp time (153 v 77 minutes; p = 0.014). Multivariate modeling demonstrated a reduction in the odds of being a responder by 57% for every 60 minutes of cardiopulmonary bypass duration (odds ratio, 0.43; 95% confidence interval, 0.28-0.68; p < 0.001), but there was no significant difference based on time from intensive care unit admission to hydroxocobalamin administration (odds ratio, 0.95; 95% confidence interval, 0.88-1.03; p = 0.20).ConclusionShorter total bypass duration and more rapid utilization after bypass of hydroxocobalamin were associated with a higher likelihood of response to refractory vasoplegic shock.Copyright © 2022 Elsevier Inc. All rights reserved.

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