A Pilot, Double-Blind, Randomized, Controlled Trial of High-Dose Intravenous Vitamin C for Vasoplegia After Cardiac Surgery.

Fumitaka Yanase, Laurent Bitker, Lara Hessels, Eduardo Osawa, Thummaporn Naorungroj, Salvatore L Cutuli, Paul J Young, Jay Ritzema, Georgia Hill, Charlotte Latimer-Bell, Anna Hunt, Glenn M Eastwood, Andrew Hilton, Rinaldo Bellomo

Journal: Journal of cardiothoracic and vascular anesthesia 2021;34(2):409-416

PMID: 31526557

Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVE

To conduct a pilot feasibility and physiologic efficacy study of high-dose vitamin C in patients with vasoplegia after cardiac surgery.

DESIGN

Prospective, double-blind, randomized, controlled trial.

SETTING

Two tertiary intensive care units (ICUs).

PARTICIPANTS

Post-cardiac surgery patients with vasoplegia.

INTERVENTIONS

The authors randomly assigned the patients to receive either high-dose intravenous vitamin C (1,500 mg every 6 hours) or placebo. The primary outcome was time from randomization to resolution of vasoplegia. Secondary outcomes included total norepinephrine equivalent dose in the first 2 days, ICU length of stay, ICU mortality, and in-hospital mortality.

MEASUREMENTS AND MAIN RESULTS

The authors studied 50 patients (25 patients in each arms). The mean (standard deviation) time to resolution of vasoplegia was 27.0 (16.5) hours in the vitamin C group versus 34.7 (41.1) hours in the placebo group (mean decrease with vitamin C of 7.7 hours, 95% confidence interval -10.5 to 25.9, p = 0.40). The median (interquartile range) norepinephrine equivalent dose in the first 2 days was 64.9 (23.5-236.5) µg/kg versus 47.4 (21.4-265.9) µg/kg in the vitamin C and placebo group (p = 0.75). The median duration of ICU admission was similar (1.4 [0.5-2.5] days and 1.5 [0.5-3.3] days in the vitamin C and placebo group; p = 0.36). Only 1 patient, in the vitamin C arm, died.

CONCLUSION

In patients with post-cardiac surgery vasoplegia, high-dose vitamin C infusion was feasible, appeared safe, and, within the limitations of a pilot study, did not achieve statistically faster resolution of vasoplegia.

Address: Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia.; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Service de médecine intensive et réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Department of Intensive Care, Austin Hospital, Melbourne, Australia.; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand.; Department of Intensive Care, Wellington Hospital, Wellington, New Zealand.; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia; Centre for Integrated Critical Care, Department of Medicine & Radiology, University of Melbourne, Melbourne, Australia. Electronic address: [email protected].

DOI: 10.1053/j.jvca.2019.08.034

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MeSH Terms: Ascorbic Acid, Cardiac Surgical Procedures, Double-Blind Method, Humans, Pilot Projects, Prospective Studies, Vasoplegia