• Martin W Dünser, Olivier Bouvet, Hans Knotzer, Nish Arulkumaran, Ludhmila Abrahao Hajjar, Hanno Ulmer, and Walter R Hasibeder.
• Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria. Electronic address: martin.duenser@i-med.ac.at.
• J. Cardiothorac. Vasc. Anesth. 2018 Oct 1; 32 (5): 2225-2232.

ObjectiveTo summarize the results of randomized controlled trials on the use of vasopressin as a vasopressor agent in cardiac surgery.DesignMeta-analysis.ParticipantsSix-hundred-twenty-five adult patients undergoing elective or emergency cardiac surgery.InterventionsArginine vasopressin infusion (n = 313) or control/standard therapy (n = 312).Measurements And Main ResultsThe rates of perioperative complications and postoperative mortality were used as primary and secondary endpoints, respectively. Fixed and/or random effects models were used to compare pooled odds ratios. Arginine vasopressin reduced the pooled odds ratio (OR) of perioperative complications (OR, 0.33; 95% confidence interval [CI], 0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest trial showed an unchanged reduction in perioperative complications (OR, 0.35; 95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative complication separately, vasopressin reduced the pooled OR of vasodilatory shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of postoperative death was not different between patients treated with arginine vasopressin and those receiving standard therapy or placebo (OR, 0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary endpoint suggested a relevant publication bias. All included trials suffered from a high risk of bias.ConclusionOur meta-analysis suggests that arginine vasopressin may reduce the rate of perioperative complications in patients undergoing elective or emergency cardiac surgery. No difference in postoperative mortality was observed. An adequately powered multicenter trial is required for reliable estimation of the effects of arginine vasopressin on perioperative complication rates and mortality in cardiac surgical patients.Copyright © 2018 Elsevier Inc. All rights reserved.

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