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The use of metaraminol as a vasopressor in critically unwell patients: a narrative review and a survey of UK practice Cover

The use of metaraminol as a vasopressor in critically unwell patients: a narrative review and a survey of UK practice

Open Access
|Aug 2022

Figures & Tables

Fig. 1

PRISMA flow chart of the study selection process

Fig. 2

Use of metaraminol as first line vasopressor, in the critical care setting, based on the critical care capacity

Survey questions used to collect data on metaraminol use in hospitals in United Kingdom

We are conducting a survey to evaluate the frequency and circumstances of metaraminol use in critical care settings in the UK. Your answers will not be discussed individually, and data will not be identifiable, as they will only be used as part of the whole sample.
1. Do you use metaraminol in the pre-critical care setting in your hospital?
2. If so, under which circumstances?
3. If metaraminol was started pre-ICU, is it continued in the critical care?
4. Do you ever use metaraminol as a first line vasopressor in Critical Care?
5. If so, under which circumstances?

Reported use of metaraminol in pre-critical areas as per the size of the critical care capacity

All pre-critical care areasEmergency department/resusTheatresRecoveryAmbulance/ TransferWards
All respondent (26 hospitals)23 (88%)16 (70%)9 (39%)5 (22%)1 (4%)16 (70%)
<10 bedded (4 hospitals)4 (100%)4 (100%)2 (50%)1 (25%)03 (75%)
10-20 bedded (10 hospitals)9 (90%)4 (40%)2 (20%)005 (50%)
>20 bedded (12 hospitals)10 (83%)8 (67%)5 (42%)4 (33%)1 (8%)8 (67%)

j_jccm-2022-0017_tab_004

Author and year publishedType of articleMain medical condition reportedComments on metaraminol use
Hou et al, 2007 (24)Retrospective observational cohort studyPatients admitted to the intensive care units with septic shockMetaraminol used together with dopamine. Haemodynamic variables and impact on renal function evaluated as outcome measures.

Abu Sardaneh et al, 2021 (34)A retrospective cohort study to determine the dose equivalent between metaraminol and noradrenalinePatients with shock of any cause in the intensive care unit.The conversion dose ratio between continuous infusion metaraminol and norepinephrine ranged between 8 and 13 in the primary and sensitivity analyses.

Abu Sardaneh et al., 2021 (21)A retrospective observational studyPatients with shock of any cause in the intensive care unit.Metaraminol was the most commonly used first line vasopressor. The study reported on the practice and did not focus on outcomes.

Abu Sardaneh et al, 2021 (23)A retrospective matched observational studyPatients with shock of any cause in the intensive care unit.In critically ill patients, metaraminol used alongside norepineohrine may be associated with a longer time to resolution of shock compared with those who only receive norepinephrine.

Da Silva and Furtado, 2018 (22)A case reportAnaphylactic shockMetaraminol mentioned as a vasopressor in shock

Anderson and Chatha, 2017 (25)Literature reviewMetaraminol use in the Emergency DepartmentConcluded that it is widely used in the emergency department setting with little evidence to support the practice.

Hayward et al, 2016 (26)A review of practiceReview of medications used by Australian aeromedical prehospital and retrieval service.Metaraminol only briefly mentioned as a treatment option utilised by the Australian pre-hospital service

Redmond et al, 2013 (27)A case reportTakotsubo cardiomyopathyA patient, suffering from at that point undiagnosed Takotsubo cardiomyopathy progressed to pulseless ventricular tachycardia following bolus administration of metaraminol.

Isbister and Duffull, 2009 (28)A case reportQuetiapine overdoseMetaraminol used successfully to maintain blood pressure (as opposed to conventional vasopressors)

Dewachter et al, 2007 (29)A review of current practicePerioperative anaphylaxisMetaraminol briefly mentioned as a vasopressor used to treat hypotension

Brown, 2005 (30)Review of management of anaphylaxisAnaphylactic shockMetaraminol briefly mentioned as a vasoconstrictor in shock.

Wood et al, 2005 (31)A case reportAmlodipine overdoseMetaraminol used successfully to maintain blood pressure (as opposed to conventional vasopressors)

Holmes, 2005 (32)Opinion pieceOpinion piece on vasopressors in the Intensive CareMetaraminol mentioned alongside other vasopressors used to treat hypotension

Review of articles selected by our literature review regarding the use of metaraminol in critical care settings

Author and year of studyType of the studyNumber of patients and populationOutcome(s) evaluatedNarrative outcomeQuality assessment
Natalini et al, 2005(35)Prospective cohort study10 patients in with septic shock. All initially started on norepinephrine, then changed to metaraminol, dose titrated to reach same mean arterial blood pressure. Pulmonary catheter used for measurement of haemodynamic variables.- Haemodynamic variables; - Medication doses needed to maintain same blood pressure; - Acid-base status - Cardiac output increase of more than 30%No significant changes in haemodynamic variables. No relationship between norepinephrine and metaraminol doses (R2=0.087), needed to maintain the same mean arterial blood pressure was found.The sample size was small. The study was not blinded. Only immediate effect was evaluated, and the authors did not comment on the effects that metaraminol can have on long term outcomes

Ruchti et al, 2021(33)Prospective observational study100 patients with shock or hypotension of any cause. First 50 given metaraminol, other 50- norepinephrine.- Haemodynamic variables; - Duration of vasopressor support - Need of central venous catheter - Cost of treatmentNo statistically significant changes in measured clinical outcomes were found in both groups. Cost of treatment was significantly higher in metaraminol group.Patients were not randomised to intervention. Norepinephrine administered peripherally, which is not standard practice. Study presented as a letter, hence limited information available regarding methods and results.
DOI: https://doi.org/10.2478/jccm-2022-0017 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 193 - 203
Submitted on: Jan 21, 2022
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Accepted on: Jun 14, 2022
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Published on: Aug 12, 2022
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2022 Lina Grauslyte, Nathalie Bolding, Mandeep Phull, Tomas Jovaisa, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.