Madeline Blaha, MBA, PharmD
Nebraska Medicine - Nebraska Medical Center
Omaha, NE
Disclosure information not submitted.
Meghan Blais, BCCCP
Clinical Pharmacist, Adult Critical Care
Nebraska Medicine, United States
Disclosure information not submitted.
Logan Olson, BCCCP, PharmD
Clinical Pharmacist, Adult Critical Care
Nebraska Medicine, United States
Disclosure information not submitted.
Title: Durability of Intravenous Hydroxocobalamin in Vasoplegia
Introduction/ Hypothesis: Vasoplegia is characterized by severe vasodilation resulting in low systemic vascular resistance. Initially treated with catecholamines and/or vasopressin, refractory cases have been trialed on intravenous (IV) hydroxocobalamin (B12). The objective of this study was to quantify the duration of hemodynamic improvement after B12 administration and characterize responders and non-responders.
Methods: This was a retrospective chart review of adult patients who received B12 while on vasopressors in the intensive care unit between June 1, 2018 and June 30, 2021. If more than one IV B12 dose was administered, only the first was evaluated. Vasopressor requirements were recorded in norepinephrine-equivalent (NEE) rates every 15 minutes for 12-hours after B12 administration. Patients were classified as “responders” if they experienced a ≥10% decrease in baseline vasopressor requirements within 60 minutes of B12 administration. B12 activity duration was defined as time from responder qualification to first increase in NEE requirements. Baseline characteristics, hospital mortality, and B12 infusion time were collected for responders and non-responders.
Results: A total of 16 patients were included and 5 (31%) met “responder” criteria. Median time to response was 15 minutes and was maintained for 210 minutes. Median baseline NEE rate was 32.9 mcg/min in responders and 24.7 mcg/min in non-responders. Responders’ NEE requirements decreased to 16.7 mcg/min after 15 minutes, and 14.8 mcg/min after 60 minutes. All responders and 10 (91%) non-responders required mechanical ventilation, both groups were mostly male (60% and 91%) and had a median age of 54 years and 58 years respectively. A total of 4 (80%) responders and 10 (91%) non-responders died while hospitalized. IV B12 was administered at a rate of 5g over 15 minutes in all but 2 patients (1 responder and 1 non-responder) who each received 5g B12 over 360 minutes.
Conclusions: Vasopressor requirements decreased rapidly in 31% of patients after IV B12 administration and remained so for 3.5 hours. Most patients died during hospitalization (87.5%), suggesting our cohort was high acuity receiving B12 for salvage therapy. Future studies should be performed to determine if extending the infusion of B12 results in sustained vasopressor requirement reduction.