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

J Cardiothorac Vasc Anesth. 2019 Mar;33(3):663-673. doi: 10.1053/j.jvca.2018.08.208. Epub 2018 Aug 31.

Abstract

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.

Keywords: cardiac surgical procedures; echocardiography; hemodynamics; milrinone; vasodilator agents.

MeSH terms

  • Administration, Inhalation
  • Administration, Intravenous
  • Adult
  • Aged
  • Cardiac Surgical Procedures / trends*
  • Female
  • Hemodynamics / drug effects*
  • Hemodynamics / physiology
  • Humans
  • Male
  • Middle Aged
  • Milrinone / administration & dosage*
  • Network Meta-Analysis*
  • Vasodilator Agents / administration & dosage*

Substances

  • Vasodilator Agents
  • Milrinone