Volume 9- No. 9 2021

Educated Hand Publishing LLC 
“The Science Behind the Art” 
Volume 9 - No.9 2021 

 Anesthesia eJournal - Online
ISSN 2333-2611

Page 17

Off-label Rescue Agents for Vasoplegic Syndrome after Cardiopulmonary Bypass 
Jessica Gatehouse, BSN, RN, CCRN  

Affiliation:
Texas Christian University 

Grant/Financial Support: 
None 

KEYWORDS: Methylene blue, Vasoplegia, Cardiopulmonary bypass, Cardiac Surgery, Hydroxocobalamin

Abstract
Cardiovascular disease is the number one cause of death in the United States today1. Cardiopulmonary bypass (CPB) 
is a common technique used in the surgical management of cardiovascular disease. A relatively common complication 
of CPB is vasoplegia, which has an approximate incidence of anywhere from 5-25%1-8. Methylene blue is used to treat 
vasoplegic syndrome (VS) when higher dose vasopressors are ineffective. Vasoplegic syndrome (VS) is defined as a 
syndrome of low systemic vascular resistance (SVR) in the presence of normal or high cardiac output1-4. Generally, VS 
is characterized as a high cardiac output state (CI < 2.2 L/min/m2) with difficulty maintaining a mean arterial pressure 
(MAP) greater than 60 mmHg despite increasing vasopressor requirements1-3,7. The focus of this case report is to 
examine methylene blue’s effectiveness in treating vasoplegia after weaning from CPB. This case report will also compare 
and contrast methylene blue and another rescue agent, hydroxocobalamin, and how they combat vasoplegia.

AEJ