Vasopressin for hemodynamic stability and cardiac tissue repair in post-cardiotomy pediatric patients: A retrospective observational study

Objectives: Vasopressin is increasingly used in pediatric intensive care unit for circulatory support; however, evidence on its hemodynamic benefits, survival impact, and adverse effect profile remains limited. This study aims to evaluate the effect of vasopressin on hemodynamic parameters in post-cardiotomy pediatric patients (as a foundation for cardiac repair), assess its influence on 30-day survival compared with data from the National Congenital Heart Defects Association (NCHDA), and analyze associated adverse effects. Methods: This was a retrospective observational study that included pediatric patients admitted to the intensive care unit between July 2016 and July 2021 who received vasopressin infusion. Collected data included demographics, hemodynamic parameters, vasoactive-inotropic scores at baseline, 24, and 48 hours, infusion duration, intensive care unit length of stay, 30-day mortality, and adverse events. Outcomes were compared with NCHDA audit data. Results: A total of 96 children received vasopressin, with 70 admitted for cardiac and 26 for non-cardiac indications. The mean age was < 1 year in both groups. Non-cardiac patients required extra-corporeal membrane oxygenation more frequently (46.2% vs. 22.9%), while 30-day survival was slightly higher in the cardiac cohort (85.7% vs. 80.8%). Vasopressin infusion was associated with significant improvements in systolic (P = 7 × 10−7), mean (P = 2.1 × 10−3), and diastolic blood pressure (P = 3.5 × 10−4) at 24 hours, thereby optimizing the perfusion groundwork essential for cardiac repair. Vasoactive-inotropic score did not change significantly at 24 hours but decreased by 48 hours (P = 6 × 10−6), reflecting reduced inotrope requirements and a potentially more favorable metabolic environment for cardiac repair. Each additional day of vasopressin use was associated with a 3.2–6.7-day increase in intensive care unit stay (P = 8 × 10−6). No adverse events associated with vasopressin infusions were observed. Conclusion: Vasopressin appears to be a safe adjunct for improving hemodynamics and reducing vasoactive requirements in the pediatric intensive care unit, particularly at low doses. By improving hemodynamic stability without increasing adverse events, vasopressin may provide a physiological environment that supports endogenous reparative and regenerative processes in pediatric cardiac patients. However, prolonged use is associated with a longer intensive care unit stay, without evidence of improved short-term survival. The hemodynamic stability it provides, despite prolonging intensive care unit stay, can be beneficial for the repair of cardiac tissue damage. Key Words: congenital heart defects; hemodynamic support; pediatric cardiac surgery; pediatric intensive care; regenerative medicine; vasoactive-inotropic score; vasopressin