Impact of Milrinone Administration in Adult Cardiac Surgery Patients: Updated Meta-Analysis

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• 作者：Masahiro Ushio ; MD^* ; Moritoki Egi ; MD ; PhD^&dagger ; ; ^{moriori@tg8.so-net.ne.jp} ; Junji Wakabayashi ; MD^&dagger ; ; Taichi Nishimura ; MD^&dagger ; ; Yuji Miyatake ; CE^&Dagger ; ; Norihiko Obata ; MD ; PhD^&dagger ; ; Satoshi Mizobuchi ; MD ; PhD^&dagger ;
• 关键词：milrinone ; cardiac surgery ; outcomes ; mortality
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：30
• 期：6
• 页码：1454-1460
• 全文大小：1728 K
• 卷排序：30

文摘

To determine the effects of milrinone on short-term mortality in cardiac surgery patients with focus on the presence or absence of heterogeneity of the effect.DesignA systematic review and meta-analysis.Setting and ParticipantsFive hundred thirty-seven adult cardiac surgery patients from 12 RCTs.InterventionsMilrinone administration.Measurements and Main ResultsThe authors conducted a systematic Medline and Pubmed search to assess the effect of milrinone on short-term mortality in adult cardiac surgery patients. Subanalysis was performed according to the timing for commencement of milrinone administration and the type of comparators. The primary outcome was any short-term mortality. Overall analysis showed no difference in mortality rates in patients who received milrinone and patients who received comparators (odds ratio = 1.25, 95% CI 0.45-3.51, p = 0.67). In subanalysis for the timing to commence milrinone administration and the type of comparators, odds ratio for mortality varied from 0.19 (placebo as control drug, start of administration after cardiopulmonary bypass) to 2.58 (levosimendan as control drug, start of administration after cardiopulmonary bypass).ConclusionsAmong RCTs to assess the effect of milrinone administration in adult cardiac surgery patients, there are wide variations of the odds ratios of administration of milrinone for short-term mortality according to the comparators and the timing of administration. This fact may suggest that a simple pooling meta-analysis is not applicable for assessing the risk and benefit of milrinone administration in an adult cardiac surgery cohort.