Which Protocol for Milrinone to Treat Cerebral Vasospasm Associated With Subarachnoid Hemorrhage?

Journal of Neurosurgical Anesthesiology
Thibaud CrespyJean-François Payen

Abstract

Milrinone has emerged as an option to treat delayed cerebral ischemia after subarachnoid hemorrhage. However, substantial variation exists in the administration of this drug. We retrospectively assessed the effectiveness of 2 protocols in patients with angiographically proven cerebral vasospasm. During 2 successive periods, milrinone was administered using either a combination of intra-arterial milrinone infusion followed by intravenous administration until day 14 after initial bleeding (IA+IV protocol), or a continuous intravenous milrinone infusion for at least 7 days (IV protocol). The primary endpoint was the reversion rate of vasospastic arterial segments following the first IA infusion of milrinone (IA+IV protocol) compared with the reversion rate during the first week of IV infusion (IV protocol). There were 24 and 77 consecutive patients in IA+IV and IV protocols, respectively. The reversion rate was comparable between the 2 protocols: 71% (95% confidence interval [CI], 59%-83%) in the IA+IV protocol versus 64% (95% CI, 58%-71%) in the IV protocol (P=0.36). Rescue procedures for persistence or recurrence of vasospasm, that is, mechanical angioplasty and/or IA milrinone infusion, were similar between the 2 protocols. Pat...Continue Reading

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Citations

Feb 23, 2020·Critical Care Nursing Quarterly·Keaton S SmetanaCasey C May
Jan 24, 2020·Journal of Neurosurgical Anesthesiology·Jeffrey J Pasternak
Oct 5, 2019·CNS Neuroscience & Therapeutics·Badih J DaouAditya S Pandey
Jan 23, 2021·Journal of Neurosurgical Anesthesiology·Jeffrey J Pasternak
Jan 23, 2021·Journal of Neurosurgical Anesthesiology·Thomas D BernierMark R Angle
Mar 29, 2020·Journal of Neurosurgery·Yasser B AbulhasanMark R Angle

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