We are seeing patients in-person and through Video Visits. Learn more about how we’re keeping you safe and please review our updated visitor policy. Please also consider supporting Weill Cornell Medicine’s efforts to support our front-line workers.
Department of Anesthesiology

You are here

Intravenous and Inhaled Milrinone in Adult Cardiac Surgery Patients: A Pairwise and Network Meta-Analysis.

TitleIntravenous and Inhaled Milrinone in Adult Cardiac Surgery Patients: A Pairwise and Network Meta-Analysis.
Publication TypeJournal Article
Year of Publication2018
AuthorsRong LQ, Rahouma M, Abouarab A, Di Franco A, Calautti NM, Fitzgerald MM, Arisha MJ, Ibrahim DA, Girardi LN, Pryor KO, Gaudino M
JournalJ Cardiothorac Vasc Anesth
Date Published2018 Aug 31

OBJECTIVE: To summarize the evidence on the hemodynamic, echocardiographic, and clinical effects of inhaled and intravenous milrinone (iMil and IvMil) in adult cardiac surgery patients.

DESIGN: Systematic review, pairwise and network meta-analysis.

SETTING: Multi-institutional.

PARTICIPANTS: Adult cardiac surgery patients.

INTERVENTIONS: Comparison between iMil and IvMil versus other agents or placebo.

MEASUREMENTS AND MAIN RESULTS: The primary endpoints were mean pulmonary artery pressure (MPAP) and peripheral vascular resistance (PVR). Secondary endpoints included the following: (1) mean arterial pressure, heart rate, and cardiac index (CI); (2) echocardiographic data; and (3) clinical outcomes. Random model, leave-one-out-analysis, and meta-regression were used. Thirty studies (6 iMil and 24 IvMil) were included for a total of 1,438 patients (194 iMil and 521 IvMil). IvMil was associated with a lower MPAP, lower PVR, and higher CI compared to placebo (standardized mean difference [SMD] = -0.22 [95% CI = -0.48 to 0.05], SMD = -0.49 [95% CI = -0.71 to -0.27], and SMD = 0.94 [95% CI = 0.51 to 1.37]). No difference in any outcome was found between iMil and placebo. At network meta-analysis, significantly lower PVR and shorter hospital length of stay were found for IvMil compared to iMil (SMD = -0.82 [95% CI = -1.53 to -0.10] and SMD = -0.50 [95% CI = -0.95 to -0.05], respectively).

CONCLUSION: These results support the clinical use of IvMil in cardiac surgery patients. No evidence at present supports the adoption of iMil.

Alternate JournalJ. Cardiothorac. Vasc. Anesth.
PubMed ID30287183