Skip to main content Accessibility help

Clinical response to arginine vasopressin therapy after paediatric cardiac surgery

  • Christopher W. Mastropietro (a1), Maria C. Davalos (a2), Shivaprakash Seshadri (a3), Henry L. Walters (a3) and Ralph E. Delius (a3)...



To describe the haemodynamic response of children who receive arginine vasopressin for haemodynamic instability after cardiac surgery and to identify clinical variables associated with a favourable response.

Materials and Methods

We reviewed patients less than or equal to 6 years undergoing open heart surgery in our institution between January, 2009 and July, 2010 who received arginine vasopressin during the first 7 days post operation. Favourable responders were defined as those in whom blood pressure was increased or maintained and catecholamine score was decreased, or blood pressure was increased by greater than or equal to 10% of baseline and catecholamine score was unchanged at 6 hours following arginine vasopressin initiation.


Of the 34 patients identified, 17 (50%) patients responded favourably to arginine vasopressin. At 6 hours, the mean blood pressure was increased by 32.2% in responders as compared with 4.6% in non-responders, with a p-value less than 0.001. The mean catecholamine score decreased by 30.1% in responders and increased by 7.6% in non-responders, with a p-value less than 0.001. Anthropometric, demographic, and intra-operative variables were similar in both groups, as was maximum dose of arginine vasopressin. The median time after arrival to the intensive care unit at which arginine vasopressin was initiated, however, was later in those who responded, 20 hours as compared with those who did not, 6 hours, with a p-value equal to 0.032.


Arginine vasopressin therapy led to haemodynamic improvement in only half of the children in this study, and improvement was more likely to occur if arginine vasopressin was initiated after the post-operative night.


Corresponding author

Correspondence to: Dr C. W. Mastropietro, MD, Department of Pediatrics, Children's Hospital of Michigan, Carl's Building, 4th floor, 3901 Beaubien Street, Detroit, Michigan 48201, United States of America. Tel: 313 745 7495; Fax: 313 966 0105; E-mail:


Hide All
1. Rosenzweig, EB, Starc, TJ, Chen, JM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100: II-182–II-186.
2. Lechner, E, Hofer, A, Mair, R, Moosbauer, W, Sames-Dolzer, E, Tulzer, G. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur J Pediatr 2007; 166: 12211227.
3. Jerath, N, Frndova, H, McCrindle, BW, Gurofsky, R, Humpl, T. Clinical impact of vasopressin infusion on hemodynamics, liver and renal function in pediatric patients. Intensive Care Med 2008; 34: 12741280.
4. Mastropietro, CW, Clark, JA, Delius, RE, Walters, HL 3rd, Sarnaik, AP. Arginine vasopressin to manage hypoxemic infants after stage I palliation of single ventricle lesions. Pediatr Crit Care Med 2008; 9: 506510.
5. Mastropietro, CW, Rossi, NF, Clark, JA, et al. Relative deficiency in arginine vasopressin in children after cardiopulmonary bypass. Crit Care Med 2010; 38: 20522058.
6. Morrison, WE, Simone, S, Conway, D, Tumulty, J, Johnson, C, Cardarelli, M. Levels of vasopressin in children undergoing cardiopulmonary bypass. Cardiol Young 2008; 18: 135140.
7. Lacour-Gayet, F, Jacobs, JP, Clarke, DR, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911924.
8. Wernovsky, G, Wypij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 22262235.
9. Killinger, JS, Hsu, DT, Schleien, CL, Mosca, RS, Hardart, GE. Children undergoing heart transplant are at increased risk for postoperative vasodilatory shock. Pediatr Crit Care Med 2009; 10: 335340.
10. Tibby, SM, Hatherhill, M, Murdoch, IA. Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive care patients. Arch Dis Child 1999; 80: 163166.
11. Scheurer, MA, Thiagarajan, RR. Vasoactive-inotropic score as a measure of pediatric cardiac surgical outcomes. Pediatr Crit Care Med 2010; 11: 307308.
12. Holmes, CL, Landry, DW, Granton, JT. Science review: vasopressin and the cardiovascular system part 2 – clinical physiology. Crit Care 2004; 8: 1523.
13. Choong, K, Kissoon, N. Vasopressin in pediatric septic shock and cardiac arrest. Pediatr Crit Care Med 2008; 9: 372379.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed