Administration of Methylene Blue to Facilitate the Management of Post-Cardiac Arrest Refractory Shock.

A 50-year-old man with recurrent hypothermia-associated ventricular fibrillation arrests presented with refractory vasoplegic shock requiring maximum institutional doses of norepinephrine (3.0 μg/min), vasopressin (0.06 units/min), and epinephrine (1.0 μg/kg/min).

Following administration of a 2 mg/kg methylene blue bolus and 0.5 mg/kg/h continuous infusion, the patient demonstrated rapid hemodynamic stabilization with vasopressor down-titration, lactate clearance (20-7.6 mmol/L), and acidosis correction (pH 6.93-7.4) within 11 hours.