Evidence map›Paper›PMID 40634185›Full record

ArticleBritish journal of anaesthesia2025

Hydroxocobalamin for vasoplegia in cardiac surgery: a retrospective cohort analysis.

Luai Zakaria, Karan Shah, Dongsheng Yang, Marta Kelava, Haytham Elgharably, Ashish K Khanna, Sanchit Ahuja, Benjamin Hohlfelder, Andrej Alfirevic, Andra E Duncan and 2 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Luai ZakariaDepartment of Cardiothoracic Anesthesiology, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, OH, USA; Outcomes Research Consortium, Houston, TX, USA. Electronic address: ZakariL@ccf.org.
Karan ShahOutcomes Research Consortium, Houston, TX, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Dongsheng YangOutcomes Research Consortium, Houston, TX, USA.
Marta KelavaDepartment of Cardiothoracic Anesthesiology, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, OH, USA; Outcomes Research Consortium, Houston, TX, USA.
Haytham ElgharablyDepartment of Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Ashish K KhannaOutcomes Research Consortium, Houston, TX, USA; Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Sanchit AhujaDepartment of Cardiothoracic Anesthesiology, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, OH, USA; Outcomes Research Consortium, Houston, TX, USA.
Benjamin HohlfelderDepartment of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
Andrej AlfirevicDepartment of Cardiothoracic Anesthesiology, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, OH, USA.
Andra E DuncanDepartment of Cardiothoracic Anesthesiology, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Nikolaos J SkubasDepartment of Cardiothoracic Anesthesiology, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, OH, USA.
Daniel I SesslerOutcomes Research Consortium, Houston, TX, USA; Center for Outcomes Research and Department of Anesthesiology, UTHealth, Houston, TX, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundVasoplegia during cardiac surgery is common and associated with perioperative mortality. Hydroxocobalamin is a catecholamine-sparing approach for treating vasoplegia. However, there is currently limited evidence to inform its use.

methodsWe conducted a single-centre retrospective propensity-matched cohort study of patients who developed vasoplegia after cardiopulmonary bypass. Our primary outcome was vasopressor requirement, expressed as norepinephrine equivalents (NEE), at 1, 4, 24, and 48 h after treatment. Our secondary outcome was a collapsed composite of in-hospital complications comprising stroke, sternal wound infection, mesenteric ischaemia, renal failure, and death.

resultsWe identified 2727 (11%) patients with vasoplegia from 2018 to 2024. The final analysis cohort included 229 matched pairs. Hydroxocobalamin administration was associated with a significant reduction in median NEE infusion rates of -0.04 (95% confidence interval [CI]: -0.07 to -0.02; P=0.008) μg kg

conclusionsHydroxocobalamin administration was associated with reduced vasopressor requirement over 24 h, but not thereafter. Robust trials are needed to determine whether this relationship is causal, and whether a reduction in vasopressor use improves substantive clinical outcomes.

Indexed as

Cardiac Surgical ProceduresHydroxocobalaminVasoplegiaAgedCardiopulmonary BypassCohort StudiesFemaleHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesVasoconstrictor AgentsHydroxocobalaminVasoconstrictor Agentscardiac surgerycardiopulmonary bypasshydroxocobalaminvasoplegiavasopressor

Identifiers

PMID40634185
PMCPMC12674016

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.