Administration of Methylene Blue to Facilitate the Management of Post-Cardiac Arrest Refractory Shock.

BACKGROUND

Post-cardiac arrest refractory shock is associated with over 50% mortality, with limited evidence-based treatment options. Methylene blue (MB) has shown promise for post-cardiopulmonary bypass vasoplegia, but its use after cardiac arrest outside the cardiac surgery setting remains unexplored.

CASE SUMMARY: A 50-year-old man with recurrent hypothermia-associated ventricular fibrillation arrests presented with refractory vasoplegic shock requiring maximum institutional doses of norepinephrine (3.0 μg/min), vasopressin (0.06 units/min), and epinephrine (1.0 μg/kg/min). Following administration of a 2 mg/kg MB bolus and 0.5 mg/kg/h continuous infusion, the patient demonstrated rapid hemodynamic stabilization with vasopressor down-titration, lactate clearance (20-7.6 mmol/L), and acidosis correction (pH 6.93-7.4) within 11 hours. The patient ultimately died from multiorgan failure.

DISCUSSION: This novel human case suggests MB may facilitate hemodynamic stabilization in post-cardiac arrest refractory shock.

TAKE-HOME MESSAGE: Earlier MB administration may warrant consideration as rescue therapy in post-cardiac arrest refractory shock when conventional vasopressors are maximized.