The following is a summary of “Limb Necrosis in the Setting of Vasopressor Use,” published in the May 2024 issue of Critical Care by Derry et al.
The link between high-dose vasopressors and limb necrosis in some patients with unstable hemodynamics remains unclear.
Researchers conducted a retrospective study identifying vasopressor-induced limb necrosis incidence and risk factors.
They reviewed medical records for patients between 18 and 89 who received vasopressor therapy at a single academic medical center (2012 to 2021). The study population was divided by the development of limb necrosis with vasopressor use. Patients with necrosis were compared to age—and sex-matched controls who did not have necrosis. Demographic information, comorbidities, and medication details were documented.
The result showed that 0.25% of patients experienced limb necrosis after receiving a vasopressor. Groups were not significantly different in terms of baseline demographics or medical comorbidities. Necrosis mainly occurs in the same limb as a femoral arterial catheter. The necrosis group received higher doses of ephedrine (P=.02) than the control group, but there were no dosage differences for other agents. Duration of therapy was longer for norepinephrine (P=.001), epinephrine (P=.04), and ephedrine (P=.01) in the necrosis group compared to controls. Each group showed no difference in the duration of vasopressin administration.
Investigators concluded that medication-specific factors, rather than patient and disease characteristics, were more relevant for guiding the clinical management of necrosis when vasopressors were administered.
