2018 FSA Posters

P013: METHYLENE BLUE AS A POTENTIAL THERAPEUTIC AGENT IN DECOMPENSATED HEMORRHAGIC SHOCK
Cory D Jackson, Christopher Giordano, MD; University of Florida

Decompensated hemorrhagic shock is characterized by decreased cardiac output and arterial pressures, a compensatory release of endogenous vasopressors, and then delayed vascular decompensation where blood vessels fail to respond to endogenous vasopressors.  Methylene blue (MB) is a heterocyclic aromatic dye used in the treatment of methemoglobinemia and as a coloring dye for medical procedures that more recently has shown potential as a therapeutic agent in various clinical settings.  The role of this agent in decompensated hemorrhagic shock has not been well studied.  Here we present a case of a 77-year-old male presented with right retroperitoneal leiomyosarcoma involving the inferior vena cava, right renal vein, and right gonadal vein.  During surgery, the patient experienced uncontrolled bleeding from the inferior vena cava that despite aggressive resuscitation with crystalloids, blood components and vasopressors still resulted in decompensated hemorrhagic shock.  He was treated with two separate doses of methylene blue during different periods of hypotension that restored his mean arterial blood pressures to the mid 60’s.  While the utility of MB has been established in cases of cardiopulmonary bypass and liver transplant during periods referred to as vasoplegia, this case suggests that methylene blue is also a potential therapeutic agent to increase mean arterial blood pressures in decompensated hemorrhagic shock during all general surgery or trauma cases.