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Use of Hydroxocobalamin (Vitamin B12a) in Patients With Vasopressor Refractory Hypotension After Cardiopulmonary Bypass

A Case Series

Armour, Sarah, MD*; Armour, Trygve K., MD*; Joppa, William R., PharmD, RPh; Maltais, Simon, MD, PhD; Nelson, James A., MBBS*; Wittwer, Erica, MD, PhD*

doi: 10.1213/ANE.0000000000003648
Hemostasis and Thrombosis: PDF Only

Hydroxocobalamin (vitamin B12a) is an emerging treatment for vasoplegic syndrome (VS) associated with cardiopulmonary bypass (CPB). Given its cost and scarcity, an institutional guideline for its use as a rescue treatment in cases of suspected VS was developed. Hemodynamic variables and vasopressor requirements were reviewed for a series of 24 post-CPB patients who received B12a. Favorable changes in hemodynamic parameters and vasopressor requirements were seen after B12a administration although guideline criteria for VS were inconsistently met. These findings support the continued study of B12a in patients with CPB-associated VS.

From the *Department of Anesthesiology & Perioperative Medicine


Department of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.

Accepted for publication June 6, 2018.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address correspondence to James A. Nelson, MBBS, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN 55905. Address e-mail to

© 2019 International Anesthesia Research Society
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