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The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

  • Marcelo Lannes (a1), Frederick Zeiler (a2), Céline Guichon (a3) and Jeanne Teitelbaum (a4)

Abstract

Objective: The purpose of this article is to provide a systematic review of the evidence supporting the use of milrinone for the management of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH). Design: Primary outcomes were functional neurological status and the incidence of cerebral infarction. Search strategies adapted to the different databases were developed by a professional librarian. Medline, EMBASE, the Cochrane Library database, Web of Science, SCOPUS, BIOSIS, Global Health, Health Star, Open SIGLE, Google Scholar and the New York Academy of Medicine Gray Literature were searched as well as clinical trials databases and the proceedings of several scientific meetings. Quality of the evidence for these outcomes across studies was adjudicated using the GRADE Working Group criteria. Results: The search resulted in 284 citations after elimination of duplicates. Of those 9 conference proceedings and 15 studies met inclusion criteria and consisted of case reports, case series and two comparative studies: one non-randomized study with physiological outcomes only and a case series with historical controls. There was considerable variation in dosing and in co-interventions and no case control or randomized controlled studies were found. Conclusion: There is currently only very low quality evidence to support the use of milrinone to improve important outcomes in patients with delayed cerebral ischemia secondary to subarachnoid hemorrhage. Further research is needed to clarify the value and risks of this medication in patients with SAH.

Utilisation de la milrinone chez les patients présentant de l’ischémie cérébrale retardée suite à une hémorragie sous-arachnoïdienne. Objectif: Le but de cet article est de présenter une revue systématique des données en faveur de l’utilisation de la milrinone dans le traitement de l’ischémie cérébrale retardée (ICR) suite à une hémorragie sous-arachnoïdienne (HSA). Méthodologie: L’état neurologique fonctionnel et l’incidence de l’infarctus cérébral étaient les critères d’évaluation primaires. Un bibliothécaire a élaboré des stratégies de recherche adaptées aux différentes bases de données. Nous avons mené des recherches dans les bases de données Medline, EMBASE, Cochrane Library, Web of Science, SCOPUS, Medicine Gray Literature ainsi que dans les bases de données portant sur les essais cliniques et les comptes rendus de réunions scientifiques. Nous avons déterminé la qualité des données concernant les résultats rapportés dans les différentes études au moyen des critères du GRADE Working Group. Résultats: Nous avons identifié 284 citations après avoir éliminé les publications redondantes. Parmi les publications retenues nous avons identifié 9 comptes rendus de réunions scientifiques et 15 études qui rencontraient les critères d’inclusion. Ces publications comportaient des études de cas et des séries de cas, et deux études comparatives : une étude non randomisée rapportant seulement l’impact physiologique du traitement et une série de cas avec témoins historiques. Il existait une variation considérable dans le dosage et les coïnterventions, et nous n’avons retrouvé aucune étude cas-témoin ou étude contrôlée et randomisée. Conclusion: Il existe actuellement seulement des données de très faible qualité à l’appui de l’utilisation de la milrinone pour améliorer l’issue d’une ischémie cérébrale retardée secondaire à une hémorragie sous-arachnoïdienne. Des études plus poussées devront être réalisées pour élucider quelle est l’efficacité et quels sont les risques que comporte cette médication chez les patients atteints d’une HSA.

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Copyright

Corresponding author

Correspondence to: Marcello Lanned, Department of Anesthesiology, Montreal Neurological Hospital, 3801 University St, room 548, Montreal, QC, H3A2B4

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Keywords

The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

  • Marcelo Lannes (a1), Frederick Zeiler (a2), Céline Guichon (a3) and Jeanne Teitelbaum (a4)

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