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Methylene blue enhancement of resuscitation after refractory hemorrhagic shock
Saber Ghiassi1, You Su Sun, Victor B Kim
1Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.
Background:
Methylene blue has been used to treat hypovolemic states. This study evaluated prehospital resuscitation after refractory hemorrhagic shock with a combination of methylene blue and limited-volume lactated Ringer's solution.
Methods:
After blood loss to a mean arterial pressure of 50 mm Hg in canines, refractory hemorrhagic shock was defined as minimal hemodynamic response to phenylephrine. Differential protocols included no treatment (control), methylene blue bolus, limited-volume lactated Ringer's solution, and combined methylene blue/lactated Ringer's solution therapies. Hemodynamic parameters were collected at baseline, during shock, during refractory hemorrhagic shock, and 30, 60, 90, and 120 minutes after treatment. Radiolabeled microspheres were used to measure end-organ perfusion and oxygen delivery.
Results:
Methylene blue/lactated Ringer's resuscitation improved prehospital survival (p < 0.05), mean arterial pressure and cardiac output (p < 0.05), vital end-organ blood flow and oxygen delivery (p < 0.05), and decreased serum lactate levels (p < 0.05), as compared with the methylene blue and lactated Ringer's single therapies.
Conclusions:
Resuscitation after refractory hemorrhagic shock using a combination of methylene blue and limited-volume lactated Ringer's solution improves prehospital survival and hemodynamic stability and reduces ischemic damage in an acute setting. This form of therapy has been proved useful as a temporizing measure for resuscitation after refractory hemorrhagic shock in a canine model and warrants further study for its application to the hemorrhagic trauma patient.
