6/30/23, 12:10 AM VANCS Pathway Feedback Search Clinical Topics Home Studies VANCS VANCS Trial question Is vasopressin superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome? Study design Single center Double blinded RCT Population Characteristics of study participants 46.2% female N = 330 53.8% male 330 patients (138 female, 162 male) Inclusion criteria: patients with vasoplegic shock (mean arterial pressure < 65 mmHg resistant to fluid challenge and cardiac index > 2.2 L/min/m ) after cardiac surgery Key exclusion criteria: aortic surgery, heart transplantation, preoperative use of vasopressor therapy, presence of a ventricular assist device other than an intraaortic balloon pump, severe hyponatremia, acute coronary syndrome, acute mesenteric ischemia, history of Raynaud disease, pregnancy and neoplasm Interventions N=149 vasopressin (0.01-0.06 U/min) N=151 norepinephrine (10-60 g/min) Primary outcome Rate of death or severe postoperative complications within 30 days 49.0 % 49 36.8 % 32 24.5 % Significant decrease 12.3 % https://web.pathway.md/studies/recyx5BwFB0XvLF0k 1/2 6/30/23, 12:10 AM VANCS Pathway NNT = 6 0.0 % Vasopressin Norepinephrine Significant decrease in the rate of death or severe postoperative complications within 30 days (32% vs. 49%; HR 0.55, 95% CI 0.38 to 0.8) Secondary outcomes Significant decrease in the rate of AF by day 30 (63.8% vs. 82.1%; OR 0.37, 95% CI 0.22 to 0.64) Safety outcomes No significant differences in adverse events including digital ischemia, mesenteric ischemia, hyponatremia, and myocardial infarction. Conclusion In patients with vasoplegic shock (mean arterial pressure < 65 mmHg resistant to fluid challenge and cardiac index > 2.2 L/min/m ) after cardiac surgery, vasopressin was superior to norepinephrine with respect to the rate of death or severe postoperative complications within 30 days. Reference Hajjar LA, Vincent JL, Barbosa Gomes Galas FR et al. Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial. Anesthesiology. 2017 Jan;126(1):85-93. Open reference URL https://web.pathway.md/studies/recyx5BwFB0XvLF0k 2/2