cardiac

Vitamin C for vasoplegia after cardiac surgery

June 24, 2018 by Neil Riordan Leave a Comment

Cardiac vasoplegia is a common complication after cardiac surgery. In this study, 3 patients received high-dose intravenous vitamin C after a bypass and saw a reduction in their need for vasopressors (drugs to contract their blood vessels) – 2 of them were taken off norepinephrine in 24 hours.

A A Pract. 2018 Feb 27. doi: 10.1213/XAA.0000000000000752

Vitamin C for Vasoplegia After Cardiopulmonary Bypass: A Case Series.

Wieruszewski PM, Nei SD, Maltais S, Schaff HV, Wittwer ED.

Abstract

Cardiac vasoplegia remains a significant contributor of morbidity and mortality in cardiac surgery patients after cardiopulmonary bypass. Effective therapeutic options for vasopressor-refractory vasoplegia are limited. We report 3 patients in whom we administered high-dose intravenous ascorbic acid (vitamin C), a cofactor for endogenous catecholamine synthesis, to treat vasoplegia refractory to epinephrine, vasopressin, and norepinephrine after surgery requiring cardiopulmonary bypass. Reductions in vasopressor requirements were observed in all 3 patients, and, in 2 patients, norepinephrine was completely discontinued within 24 hours. Ascorbic acid is a novel potential therapeutic option for cardiac vasoplegia that warrants rigorous prospective studies.

PMID: 29634537

High-dose intravenous vitamin C proposed after cardiac arrest

June 15, 2018 by Neil Riordan Leave a Comment

This is a review article from the Annual Update in Intensive Care and Emergency Medicine 2018, where they argue that high-dose intravenous vitamin C is no longer alternative medicine, and they recommend the use of after cardiac arrest to prevent damage by ischemia.

Crit Care. 2018 Mar 20;22(1):70. doi:10.1186/s13054-018-1996-y

Making sense of early high-dose intravenous vitamin C in ischemia/reperfusion injury.

Spoelstra-de Man AME, Elbers PWG, Oudemans-van Straaten HM.

Abstract (Conclusion)

An increasing number of preclinical and clinical studies show that high-dose i. v. vitamin C can mitigate systemic, cerebral and myocardial ischemia/reperfusion injury. Vitamin C administration has been associated with reduced oxidative stress, myocardial injury and arrhythmias and improved microcirculation, neurological outcome and survival, although not all studies showed benefit. Because of the common pathophysiological pathway of sepsis and ischemia/reperfusion injury, the potential role of vitamin C for ischemia/reperfusion injury is further supported by the results of preliminary sepsis studies, showing earlier recovery from organ failure and higher survival rates. Therefore, early, high-dose i. v. vitamin C is a promising therapeutic intervention after cardiac arrest to diminish the systemic ischemia/reperfusion injury due to overwhelming oxidative stress. The supportive evidence from preclinical and clinical studies is too large to continue considering early high-dose i. v. vitamin C as alternative medicine. An RCT is urgently required to provide definitive proof as to whether this cheap and safe therapy does indeed improve outcome.

PMID: 29558975 PMCID: PMC5861638

Vitamin C decreases atrial fibrillation incidence post-surgery

February 5, 2017 by Neil Riordan Leave a Comment

Atrial fibrillation (AF) is a common complication after cardiac surgery, affecting up to 30% of patients. Since oxidative stress is associated with AF, several studies in recent years have investigated the effects of post-surgery treatment with Vitamin C, an antioxidant. Hemilä and Suonsyrjä have just published a systematic review of 15 trials, ranging from 2003 to 2016. Of those, 14 trials measured the incidence of AF after cardiac surgery in a total of 2006 high-risk patients. Vitamin C was administered orally or intravenously.

Vitamin C administration in the five trials taking place in the US did not prevent AF, whereas the nine trials in the rest of the world (Greece, Slovenia, Iran, and Russia) showed a significant reduction of 44% (95% CI: 0.47-0.67) in the incidence of AF. Whether vitamin C was administered orally or intravenously made a difference in trials outside the US: intravenous vitamin C was found to reduce the length of hospital stay (1.47 days), but it was oral vitamin C that had the best results for AF (a 73% decrease).

The causes for such a great difference between US and non-US trials are not clear, but this strong evidence from other countries merits at least further investigation.

BMC Cardiovasc Disord. 2017 Feb 1;17(1):49. doi:10.1186/s12872-017-0478-5.

Vitamin C for preventing atrial fibrillation in high risk patients: a systematic review and meta-analysis.

Hemilä H, Suonsyrjä T.

BACKGROUND:

Atrial fibrillation (AF), a common arrhythmia contributing substantially to cardiac morbidity, is associated with oxidative stress and, being an antioxidant, vitamin C might influence it.

METHODS:

We searched the Cochrane CENTRAL Register, MEDLINE, and Scopus databases for randomised trials on vitamin C that measured AF as an outcome in high risk patients. The two authors independently assessed the trials for inclusion, assessed the risk of bias, and extracted data. We pooled selected trials using the Mantel-Haenszel method for the risk ratio (RR) and the inverse variance weighting for the effects on continuous outcomes.

RESULTS:

We identified 15 trials about preventing AF in high-risk patients, with 2050 subjects. Fourteen trials examined post-operative AF (POAF) in cardiac surgery patients and one examined the recurrence of AF in cardioversion patients. Five trials were carried out in the USA, five in Iran, three in Greece, one in Slovenia and one in Russia. There was significant heterogeneity in the effect of vitamin C in preventing AF. In 5 trials carried out in the USA, vitamin C did not prevent POAF with RR = 1.04 (95% CI: 0.86-1.27). In nine POAF trials conducted outside of the USA, vitamin C decreased its incidence with RR = 0.56 (95% CI: 0.47-0.67). In the single cardioversion trial carried out in Greece, vitamin C decreased the risk of AF recurrence by RR = 0.13 (95% CI: 0.02-0.92). In the non-US cardiac surgery trials, vitamin C decreased the length of hospital stay by 12.6% (95% CI 8.4-16.8%) and intensive care unit (ICU) stay by 8.0% (95% CI 3.0-13.0%). The US trials found no effect on hospital stay and ICU stay. No adverse effects from vitamin C were reported in the 15 trials.

CONCLUSIONS: Our meta-analysis indicates that vitamin C may prevent post-operative atrial fibrillation in some countries outside of the USA, and it may also shorten the duration of hospital stay and ICU stay of cardiac surgery patients. Vitamin C is an essential nutrient that is safe and inexpensive. Further research is needed to determine the optimal dosage protocol and to identify the patient groups that benefit the most.

PMID: 28143406 PMCID: PMC5286679 DOI: 10.1186/s12872-017-0478-5

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