In Australia more than 20,000 cardiac surgical operations are carried out each year. Median length of hospital stay after cardiac surgery is 9.5 days. Longer stays often reflect the accumulation of complications and result in increased healthcare costs. A reduction in these would have significant benefit to patients and the health system. Systemic vascular resistance (SVR), and consequently blood pressure is commonly low during and after cardiac surgery due to the combined effects of drugs and the surgical inflammatory response. Vasopressor infusions are used in up to 80 per cent of patients to restore SVR.
In our previous ANZCA funded pilot study comparing angiotensin II to noradrenaline we found that a double-blind, randomised controlled trial comparing these two drugs was feasible. While the study did not have sufficient power to test hypotheses, the length of hospital stay was shorter in the angiotensin II group vs noradrenaline (6.3 vs 8.1 days, p=0.04).
In this study we will carry out a double blind, randomised controlled trial in 400 patients, comparing perioperative angiotensin II infusion to noradrenaline infusion in adult patients undergoing cardiac surgery to determine if angiotensin II infusion reduces length of hospital stay compared to noradrenaline.
Dr Tim Coulson, Professor Silvana Marasco, Professor David Pilcher, The Alfred Hospital, Melbourne;
Associate Professor Lachlan Miles, Austin Health, Melbourne;
Dr Daniel Frei, Wellington Hospital, New Zealand
The project was awarded A$69,556 funding through the ANZCA research grants program for 2024.