Which Protocol for Milrinone to Treat Cerebral Vasospasm Associated With Subarachnoid Hemorrhage?. Issue 3 (July 2019)

• Record Type: Journal Article
• Authors: Crespy, Thibaud; Heintzelmann, Magali; Chiron, Celia; Vinclair, Marc; Tahon, Florence; Francony, Gilles; Payen, Jean-François
• Is Part Of: Journal of neurosurgical anesthesiology. Volume 31:Issue 3(2019:Jul.)
• Publication Date: 2019-07
• Subjects: milrinone -- therapeutic use -- vasospasm -- intracranial -- treatment outcome; Anesthesia in neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 617.96748
• DOI: 10.1097/ANA.0000000000000527
• Languages: English
• ISSNs: 0898-4921

Abstract

Abstract : Background: 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. Methods: 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). Results: 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. Patients with a good neurological outcome at 1 year, that is, modified Rankin Scale scores 0-2, were comparable between the 2 protocols. Side effects of milrinone were uncommon and equally distributed within the 2 protocols. Conclusions: These findings indicate that a continuous IV infusion of milrinone was as efficient as combined IA+IV infusion and suggest that this modality could be considered as a first easy-to-use option to treat patients with CVS.