Angiotensin II Infusion in COVID-19-Associated Vasodilatory Shock: A multinational, multicentre registry

Abstract

In December 2019, several cases of atypical pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported in Wuhan, China. This novel virus has now become responsible for a pandemic (COVID-19). In most of cases, COVID-19 is a self-limited lower respiratory tract illness. However, in some patients, it causes acute respiratory distress syndrome (ARDS), shock, myocardial injury, acute kidney injury, and multiorgan failure develop. A significant proportion of mechanically ventilated patients with COVID-19 infection require vasopressor support. Conventional and recommended agents used for such support include norepinephrine and vasopressin. Angiotensin II may be a suitable agent in patients with COVID-19 because of its potential nephroprotective effect, its potentially ability to specifically assist in patients recently exposed to angiotensin converting enzyme inhibitors (ACEIs), and because of its potential to affect the internalization and downregulation of angiotensin converting enzyme 2 (ACE2). This is relevant to COVID-19-associated critical illness because ACE is both the protein responsible for the break-down of angiotensin II to Angiotensin 1-7 and is the receptor for the viral entry into the cells. The primary aim is to generate an international, multicentre network of integrated care for patients with COVID-19 treated with angiotensin II or other novel therapy to monitor safety and to monitor outcomes. The hypothesis is that, in patients with COVID-19 receiving angiotensin II or novel therapy, additional evidence of benefit or harm can be identified, improved and used to guide further research in the field with the implementation of an international angiotensin II registry.