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Practice review
Angiotensin II for the emergency physician
  1. Marianne C Wallis1,
  2. Jonathan H Chow2,
  3. Michael E Winters3,
  4. Michael T McCurdy4
  1. 1 Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2 Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland, USA
  3. 3 Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
  4. 4 Division of Pulmonary and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Marianne C Wallis, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Mariannewallis{at}gmail.com

Abstract

Refractory hypotension is one of the most common and difficult clinical problems faced by acute care clinicians, and it poses a particularly large problem to the emergency physician when a patient in undifferentiated shock arrives in the department. Angiotensin II (Ang-2) has been previously used as a vasopressor to combat shock; the feasibility of its clinical use has been reinvigorated after approval of a human synthetic formulation of the medication by the US Food and Drug Administration in 2017 and the European Medicines Agency in 2019. A thorough literature search was completed, and in this review, we discuss the discovery and development of Ang-2, its complex mechanisms of vasoconstriction, its potential adverse effects and its potential role in clinical practice for emergency physicians.

  • clincial management
  • intensive care
  • resuscitation

https://doi.org/10.1136/emermed-2019-209062

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    Footnotes

    • Twitter @MikeMcCurdyMD

    • Correction notice This paper has been updated since first published. Third author name was incorrectly spelled as 'Micheal E Winters' and was amended to 'Michael E Winters'.

    • Contributors MCW drafted the manuscript. JHC created all figures and assisted with edits. MTMcC served as an angiotensin II expert. MEW, along with all authors, contributed substantially to the revision. All authors approve of the final version of the submitted manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MTM serves on the speaker’s bureau for La Jolla Pharmaceutical Company and was a site principle investigator in the Intravenous Angiotensin for High-Output Shock-3 study. JHC serves on the speaker’s bureau for La Jolla Pharmaceutical Company.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.