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Title of Journal: Intensive Care Med

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Abbravation: Intensive Care Medicine

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Publisher

Springer Berlin Heidelberg

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DOI

10.1007/bf01570563

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ISSN

1432-1238

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Milrinone for cardiac dysfunction in critically il

Authors: Geert Koster Hanneke J Bekema Jørn Wetterslev Christian Gluud Frederik Keus Iwan C C van der Horst
Publish Date: 2016/07/22
Volume: 42, Issue: 9, Pages: 1322-1335
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Abstract

Milrinone is an inotrope widely used for treatment of cardiac failure Because previous metaanalyses had methodological flaws we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunctionThis systematic review was performed according to The Cochrane Handbook for Systematic Reviews of Interventions Searches were conducted until November 2015 Patients with cardiac dysfunction were included The primary outcome was serious adverse events SAE including mortality at maximum followup The risk of bias was evaluated and trial sequential analyses were conducted The quality of evidence was assessed by the Grading of Recommendations Assessment Development and Evaluation criteriaA total of 31 randomised clinical trials fulfilled the inclusion criteria of which 16 provided data for our analyses All trials were at high risk of bias and none reported the primary composite outcome SAE Fourteen trials with 1611 randomised patients reported mortality data at maximum followup RR 096 95 confidence interval 076–121 Milrinone did not significantly affect other patientcentred outcomes All analyses displayed statistical and/or clinical heterogeneity of patients interventions comparators outcomes and/or settings and all featured missing dataThe current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks of both bias and random error and demonstrates no benefits The use of milrinone for the treatment of critically ill patients with cardiac dysfunction can be neither recommended nor refuted Future randomised clinical trials need to be sufficiently large and designed to have low risk of bias

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