• Michael Mazzeffi, Benjamin Hammer, Edward Chen, Mark Caridi-Scheible, James Ramsay, and Christopher Paciullo.
• Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
• Ann Card Anaesth. 2017 Apr 1; 20 (2): 178-181.

BackgroundMethylene blue (MB) has been used to treat refractory hypotension in a variety of settings.AimsWe sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB.Setting And DesignThis was conducted in a tertiary care medical center; this study was a retrospective cohort study.Materials And MethodsAdult cardiac surgery patients who received MB for post-CPB VS over a 2-year period were studied. Mean arterial blood pressure (MAP) and vasopressor doses were compared before and after MB, and logistic regression was used to model which variables predicted response.ResultsEighty-eight patients received MB for post-CPB VS during the study period. MB administration was associated with an 8 mmHg increase in MAP (P = 0.004), and peak response occurred at 2 h. Variables that were associated with a positive drug response were deep hypothermic circulatory arrest during surgery and higher MAP at the time of drug administration (P = 0.006 and 0.02). A positive response had no correlation with in-hospital mortality (P = 0.09).ConclusionsMB modestly increases MAP in cardiac surgery patients with VS. Higher MAP at the time of drug administration and surgery with deep hypothermic circulatory arrest predict a greater drug response.

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