Post cardiopulmonary bypass vasoplegia is common, and associated with poor outcomes. Traditional management strategies involving escalating doses of catecholamines, vasopressin and adjuncts such as methylene blue and hydroxycobalamin or ascorbic acid have not shown promising results.

Since ACE enzyme dysfunction, high serum renin and low endogenous angiotensin II may be a common problem in these patients, synthetic Angiotensin II is a physiologically viable option. Both post hoc results from the ATHOS-3 trial and prospective outcomes from the real world use of Angiotensin II has shown encouraging results.

More data is needed to map the renin angiotensin cascade in post cardiac surgery patients with vasoplegia and large prospective randomised trials should be done to validate these findings.

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