The following is a summary of “Systemic tolerance of intravenous milrinone administration for cerebral vasospasm secondary to non-traumatic subarachnoid hemorrhage,” published in the August 2024 issue of Critical Care by Julian et al.
Delayed cerebral ischemia (DCI) is an extreme complication of subarachnoid hemorrhage (SAH) analogous to cerebral vasospasm (CVS), treated with intravenous milrinone, an inotropic and vasodilatory agent.
Researchers conducted a retrospective study to describe milrinone’s hemodynamic, respiratory, and renal effects when administered as a treatment for CVS.
They examined patients receiving intravenous milrinone for CVS, monitoring systemic hemodynamics, oxygenation, and renal disorders and described the evolution of these parameters before and after milrinone initiation (day – 1, baseline, day 1, and day 2), studied the causes of treatment cessation, and assessed neurological outcome at 3–6 months.
The results showed that in 91 patients, milrinone initiation led to an increase in cardiac output (4.5 L/min [3.4–5.2] at baseline vs. 6.6 L/min [5.2–7.7] on day 2, P<0.001), a decrease in Mean Arterial Pressure (101 mmHg [94–110] at baseline vs. 95 mmHg [85–102] on day 2, P=0.001), an increase in norepinephrine treatment requirement (32% of patients before milrinone vs. 58% on day 1, P=0.002), and a slight deterioration in the PaO2/FiO2 ratio (401 [333–406] at baseline vs 348 [307–357] on day 2, P=0.016). Milrinone was discontinued in 8% of patients, and 55% experienced a favorable outcome.
They concluded that intravenous milrinone for CVS treatment is linked with notable effects on systemic hemodynamics, leading to discontinuation of treatment.
Source: sciencedirect.com/science/article/pii/S0883944124002946
