Angiotensin II for the Treatment of Vasodilatory Shock by ATHOS-3 trial


  • does 2 pressors (levo + ang) increase MAP compared to levo + placebo.
  • No survival benefit
  • very expensive1

Methods

AII was started at 20 ng/kg/min and adjusted to 1.25-40 ng/kg. Study infusion was discontinued at 48 hour mark.

Results

  • Mean reduction of 0.03 ug/kg/h of background vasopressors and increase in MAP within 3 hours.
  • Mean improvement in CV SOFA score at 48 hours without improvement in total SOFA score.
  • No mortality difference. 2

Follow up

  • Numerous counterpoint. 3
  • Follow up study found improvement in 28 day survival, MAP, and rate of RRT liberation.4

Footnotes

  1. CHEST Board Review Critical Care?

  2. https://www.nejm.org/doi/10.1056/NEJMoa1704154

  3. https://emcrit.org/pulmcrit/angiotensin-ii/

  4. https://journals.lww.com/ccmjournal/Fulltext/2018/06000/Outcomes_in_Patients_with_Vasodilatory_Shock_and.15.aspx