The following is a summary of “Efficacy and safety of angiotensin II in cardiogenic shock: A systematic review,” published in the April 2023 issue of Emergency Medicine by Bansal, et al.

For a systematic review, researchers sought to evaluate the current literature on the use of angiotensin II in patients with cardiogenic shock (CS). High morbidity and mortality are linked to CS. The function of angiotensin II in CS has recently attracted more attention.

A systematic search was conducted in PubMed, EMBASE, Medline, Web of Science, PubMed Central, and CINAHL databases for studies assessing the efficacy of angiotensin II in patients with CS between January 1, 2010, and July 7, 2022. Outcomes of interest were changes in mean arterial pressure (MAP), vasoactive medication requirements (percent change in norepinephrine equivalent [NEE] dose), all-cause mortality, and adverse events.

A total of 195 individuals from 15 studies were considered, 156 (80%) of whom received angiotensin II. An increase in MAP was noted in 84.6% of patients with reported data at hour 12 in case reports and case series. The positive hemodynamic response was observed in 88.9% and 35.7% of patients in the two studies. One study showed a 100% reduction in NEE dose, while eight studies noted a reduction in NEE dose at hour 12 after angiotensin II treatment. Out of 47 patients with documented information, 13 had adverse outcomes, including hepatic injury, digital ischemia, ischemic optic neuropathy, ischemic colitis, agitated delirium, and thrombotic events.

The available literature suggested that angiotensin II may improve MAP, reduce vasopressor requirements, and have minimal adverse events in patients with CS. However, given the limited number of studies and small sample sizes, further research was required to confirm these findings.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000542