Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original investigation

Methylene blue as an adjuvant during cardiopulmonary resuscitation: an experimental study in rats

Marcelo Souza Xavier, Matheus F. Vane, Roberta F. Vieira, Cristiano C. Oliveira, Debora R.R. Maia, Leticia U.C. de Castro, Maria José Carvalho Carmona, José Otávio Costa Auler Jr., Denise Aya Otsuki

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Methylene Blue (MB) has been shown to attenuate oxidative, inflammatory, myocardial, and neurological lesions during ischemia-reperfusion and has great potential during cardiac arrest. This study aimed to determine the effects of MB combined with epinephrine during cardiac arrest on myocardial and cerebral lesions.


Thirty-eight male Wistar rats were randomly assigned to four groups: the sham group (SH, n = 5), and three groups subjected to cardiac arrest (n = 11/group) and treated with EPI 20 µ−1 (EPI), EPI 20 µ−1 + MB 2−1 (EPI + MB), or saline 0.9% 0.2 ml (CTL). Ventricular fibrillation was induced by direct electrical stimulation in the right ventricle for 3 minutes, and anoxia was maintained for 5 minutes. Cardiopulmonary Resuscitation (CPR) consisted of medications, ventilation, chest compressions, and defibrillation. After returning to spontaneous circulation, animals were observed for four hours. Blood gas, troponin, oxidative stress, histology, and TUNEL stainingmeasurements were analyzed. Groups were compared using generalized estimating equations.


No differences in the Returning of Spontaneous Circulation (ROSC) rate were observed among the groups (EPI: 63%, EPI + MB: 45%, CTL: 40%, p = 0.672). The mean arterial pressure immediately after ROSC was higher in the EPI+MB group than in the CTRL group (CTL: 30.5 [5.8], EPI: 63 [25.5], EPI+MB: 123 [31] mmHg, p = 0.007). Serum troponin levels were high in the CTL group (CTL: 130.1 [333.8], EPI: 3.70 [36.0], EPI + MB: 43.7 [116.31] ng/mL, p < 0.05).


The coadministration of MB and epinephrine failed to yield enhancements in cardiac or brain lesions in a rodent model of cardiac arrest.


Cardiac arrest Epinephrine Hypoxia-ischemia Injury Methylene blue Rats Reperfusion
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