Methylene blue is associated with poor outcomes in vasoplegic shock.

Abstract

OBJECTIVES:

The purpose of this study was to investigate whether patients who received methylene blue as treatment for vasoplegia during cardiac surgery with cardiopulmonary bypass had decreased morbidity and mortality.

DESIGN:

Retrospective analysis.

SETTING:

Single tertiary care university hospital.

PARTICIPANTS:

Adult patients who suffered from vasoplegia and underwent all types of cardiac surgery with cardiopulmonary bypass at this institution between 2007 and 2008.

INTERVENTIONS:

With IRB approval, the authors reviewed the charts of the identified patients and divided them into 2 groups based on whether they had received methylene blue. Two hundred twenty-six patients were identified who met the inclusion criteria for the study. Fifty-seven of these patients had received methylene blue for vasoplegia. The authors collected data on preoperative and intraoperative variables as well as outcomes.

MEASUREMENTS AND MAIN RESULTS:

The patients who received methylene blue had higher rates of in-hospital mortality, a compilation of morbidities, as well as renal failure and hyperbilirubinemia. A multiple logistic regression model demonstrated that receiving methylene blue was an independent predictor of in-hospital mortality (p value: 0.007, OR 4.26, 95% CI: 1.49-12.12), compilation of morbidities (p value: 0.001, OR 4.80, 95% CI: 1.85-12.43), and hyperbilirubinemia (p value:<0.001, OR 6.58, 95% CI: 2.91-14.89). Using propensity score matching, the association with morbidity was again seen but the association with mortality was not found.

CONCLUSIONS:

The current study identified the use of methylene blue as treatment for vasoplegia to be independently associated with poor outcomes. While further studies are required, a thorough risk-benefit analysis should be applied before using methylene blue and, perhaps, it should be relegated to rescue use and not as first-line therapy.

• Authors: Menachem M Weiner, Hung-Mo Lin, Dennis Danforth, Srikar Rao, Leila Hosseinian, Gregory W Fischer
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 27 Issue 6 Pg. 1233-8 (Dec 2013) ISSN: 1532-8422 [Electronic] United States
• PMID: 23972738 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Antidotes
• Methylene Blue

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antidotes (adverse effects)
• Cardiac Surgical Procedures
• Cardiopulmonary Bypass (adverse effects)
• Female
• Hospital Mortality
• Humans
• Logistic Models
• Male
• Methylene Blue (adverse effects)
• Middle Aged
• Postoperative Complications (epidemiology, mortality)
• Propensity Score
• Retrospective Studies
• Treatment Outcome
• Vasoplegia (drug therapy, epidemiology, mortality)
• Young Adult