Methylene Blue Does Not Improve Vasoplegia After Left Ventricular Assist Device Implantation

Saha, Amit; Jennings, Douglas L.; Ning, Yuming; Kurlansky, Paul; Miltiades, Andrea; Spellman, Jessica; Sanchez, J.; Yuzefpolskaya, M.; Colombo, P.C.; Takayama, Hiroaki; Naka, Yoshifumi; Takeda, Koji

doi:10.1016/j.athoracsur.2020.05.172

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…Patients taking other serotonergic medications like MAO-B inhibitors and some types of tricyclic antidepressants (TCA) are also at risk 23 . There are many case reports describing the development of a serotonin syndrome after treatment with MB to counter VS [26][27][28][29][30] .…”

Section: Adverse Effects Of Methylene Bluementioning

confidence: 99%

The role of methylene blue in the management of vasoplegic syndrome: a narrative review

Cottyn¹,

Roussel²,

Rex³

et al. 2022

Acta Anaest Belg

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Vasoplegic syndrome is an important clinical entity characterized by profound arterial hypotension refractory to vasopressor therapy. The underlying pathophysiology is characterized by a complex and multifactorial dysregulation of both vasodilatory and vasoconstrictive mechanisms. During the last decades, there is growing interest in using methylene blue as an adjunct therapy to treat vasodilatory shock. The present review evaluates the safety and efficacy of methylene blue in cardiac and transplant surgery, severe sepsis and septic shock, severe burn injury, paediatric intensive care, and intoxications. Although most of the currently available evidence reports a benefit in haemodynamic parameters and a decrease in vasopressor requirements following the administration of methylene blue, study designs are heterogeneous, and the overall level of evidence is low. Moreover, a clear and consistent benefit in morbidity and mortality is lacking. Large prospective randomized controlled trials are needed to evaluate the exact role and timing of methylene blue in the treatment of vasopressor refractory vasoplegia.

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Section: Adverse Effects Of Methylene Bluementioning

confidence: 99%

The role of methylene blue in the management of vasoplegic syndrome: a narrative review

Cottyn¹,

Roussel²,

Rex³

et al. 2022

Acta Anaest Belg

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show abstract

“…Newer therapies are targeted at the various biological pathways thought to be involved in the pathophysiology of vasoplegia such as the arginine-vasopressin system (vasopressin), renin-angiotensin-aldosterone system (angiotensin II), and modulators of nitric oxide and other inflammatory mediators (methylene blue, hydroxocobalamin, vitamin C, and corticosteroids) 3 . However, studies investigating methylene blue failed to show improvement in clinical outcomes 7 .…”

Section: Introductionmentioning

confidence: 99%

Outcomes and Risk Factors for Postoperative Vasoplegia Following Implant of Continuous-Flow Left Ventricular Assist Devices

Wright,

Wilbur,

Modi

et al. 2024

Preprint

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Refractory postoperative vasoplegia following cardiac surgery and left ventricular assist device (LVAD) implantation predicts poor outcomes. We aimed to investigate outcomes and predictors of postoperative vasoplegia. We retrospectively reviewed a single-center cohort of 190 patients who received LVADs from January 2015 through March 2022 at The Ohio State Wexner Medical Center. Primary outcomes included duration of ICU stay, development of right heart failure (RHF), and mortality. Secondary outcomes included pre-implant medications and post-implant blood products. Vasoplegia was defined as physician documentation of vasoplegia with patients requiring ?1 intravenous vasopressors within 48-hours following LVAD implantation to maintain a mean arterial pressure >65 mmHg for >24 hours. Overall, 55 (29%) patients developed vasoplegia following LVAD implantation. Our sample was stratified into two cohorts: patients with vasoplegia and without vasoplegia. Baseline characteristics, LVAD indication, creatinine clearance, and comorbidities did not vary significantly between cohorts. Patients without vasoplegia were more likely to have prior implantable cardiac defibrillators (p = 0.02) and were more commonly prescribed pre-operative inotropes (p = 0.03). Blood-product administration within the first 48-hours postoperatively did not differ. While patients with vasoplegia required a longer ICU stay post-op (5 vs 7 days, p = 0.03), there were no significant differences in development of RHF (39% vs 44%), 30-day (7% vs 13%), 1-year (31% vs 29%), and 2-year mortality (39% vs 33%) in patients without and with vasoplegia, respectively. Overall, our vasoplegia rates were consistent with previous literature (29%) and vasoplegia did not confer inferior outcomes for mortality or developing RHF.

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“…Angiotensin II is the most recently published therapeutic alternative, which was reported to reduce catecholamines for VS [13,14]. The efficacy and efficiency of MB administration for VS during or after CPB has been described by several authors; however, to the best of our knowledge, evidence with larger patient collectives is lacking [15][16][17][18][19]. Previous studies using MB in VS revealed conflicting results, which might have been due to the inclusion of different anesthesiologist-triggered strategies and time-dependent factors.…”

Section: Introductionmentioning

confidence: 99%

Early Use of Methylene Blue in Vasoplegic Syndrome: A 10-Year Propensity Score-Matched Cohort Study

Kofler

Simbeck

Tomasi

et al. 2022

JCM

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Background: Vasoplegic syndrome is associated with increased morbidity and mortality in patients undergoing cardiac surgery. This retrospective, single-center study aimed to evaluate the effect of early use of methylene blue (MB) on hemodynamics after an intraoperative diagnosis of vasoplegic syndrome (VS). Methods: Over a 10-year period, all patients diagnosed with intraoperative VS (hypotension despite treatment with norepinephrine ≥0.3 μg/kg/min and vasopressin ≥1 IE/h) while undergoing heart surgery and cardiopulmonary bypass were identified, and their data were examined. The intervention group received MB (2 mg/kg intravenous) within 15 min after the diagnosis of vasoplegia, while the control group received standard therapy. The two groups were matched using propensity scores. Results: Of the 1022 patients identified with VS, 221 received MB intraoperatively, and among them, 60 patients received MB within 15 min after the diagnosis of VS. After early MB application, mean arterial pressure was significantly higher, and vasopressor support was significantly lower within the first hour (p = 0.015) after the diagnosis of vasoplegia, resulting in a lower cumulative amount of norepinephrine (p = 0.018) and vasopressin (p = 0.003). The intraoperative need of fresh frozen plasma in the intervention group was lower compared to the control group (p = 0.015). Additionally, the intervention group had higher creatinine values in the first three postoperative days (p = 0.036) without changes in dialysis incidence. The 90-day survival did not differ significantly (p = 0.270). Conclusion: Our results indicate the additive effects of MB use during VS compared to standard vasopressor therapy only. Early MB administration for VS may significantly improve the patients’ hemodynamics with minor side effects.

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Methylene Blue Does Not Improve Vasoplegia After Left Ventricular Assist Device Implantation

Cited by 7 publications

References 23 publications

The role of methylene blue in the management of vasoplegic syndrome: a narrative review

The role of methylene blue in the management of vasoplegic syndrome: a narrative review

Outcomes and Risk Factors for Postoperative Vasoplegia Following Implant of Continuous-Flow Left Ventricular Assist Devices

Early Use of Methylene Blue in Vasoplegic Syndrome: A 10-Year Propensity Score-Matched Cohort Study

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