Milrinone 30mg/50ml solution for infusion pre-filled syringes

To summarize the evidence on the hemodynamic effects and vasopressor requirements of adult patients with known pulmonary hypertension (PH) undergoing cardiac surgery treated with intravenous and inhaled milrinone. A total of 400 patients in 5 prospective (4 RCT) studies were included for pooled analysis. There was no significant difference in the primary outcome; mean pulmonary artery pressure (MPAP) between groups (MD: -4.80, 95% CI -10.57 to 0.98). Inhaled milrinone was associated with a greater systemic vascular resistance index (SVRI) (MD: 259.21, 95% CI 168.70 to 349.72) and reduction in pulmonary capillary wedge pressure (MD: -4.64, 95% CI -5.47 to -3.81). There were no observable differences in mean arterial pressure, pulmonary vascular resistance, cardiac index, or central venous pressure. All studies included were assessed to be moderate/some concern risk of bias. Inhaled milrinone has not been shown to have a significant beneficial effect on MPAP and SVR when compared to intravenous milrinone in patients with known PH undergoing cardiac surgery. However, it has shown some benefits in maintaining MAP and improving oxygenation in this patient cohort. The study is limited by the bias of the included studies and the variability of inhaled drug dosage and administration timing, further well-powered randomized controlled trials are required.

Abstract licence: CC BY-NC-SA

BackgroundInotropes play a significant role in the treatment of cardiogenic shock (CS). Phosphodiesterase 3 inhibitors (PDE3i) are being used with increasing frequency, despite limited supporting evidence.Methods and resultsWe performed a systematic review to assess the clinical importance of PDE3i in CS. The search included studies that compared the effect of 'PDE3i with or without inotropes' with 'No PDE3i with or without inotropes' in patients with cardiogenic shock. Early death, cardiac arrest, and initiation of renal replacement therapy were assessed as outcomes. We identified 2 randomized controlled trials (RCT) with a total of 224 patients who met the eligibility requirements from the PubMed, Web of Science, and CENTRAL databases, up until October 31, 2024. One RCT compared milrinone with dobutamine (DOB), and another compared enoximone with levosimendan. Meta-analysis revealed that PDE3i were neither superior nor inferior for the outcomes in the total cohort (odds ratio [OR] 1.47, 95% confidence interval [CI] 0.35-6.26 for early deaths; OR 1.14, 95% CI 0.42-3.14 for cardiac arrest; OR 1.53, 95% CI 0.80-2.92 for the initiation of renal replacement therapy).ConclusionsThe present systematic review revealed no difference in outcomes, early deaths, cardiac arrest and initiation of renal replacement therapy when using PDE3i in patients with CS treated with or without other inotropes.

Abstract licence: CC BY-NC-ND

Background: Cardiogenic shock (CS) is a life-threatening condition requiring timely pharmacological support. Dobutamine and milrinone are commonly used inotropes, yet their comparative efficacy and safety in CS management remain uncertain. This systematic review and meta-analysis aims to evaluate the outcomes associated with dobutamine versus milrinone in CS patients. Methods: A thorough literature search was conducted across databases including MEDLINE (via PubMed), CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus, spanning publications up to February 2025. Randomized controlled trials and observational studies comparing dobutamine and milrinone in adult patients diagnosed with CS were incorporated. Statistical analyses were performed employing a random-effects model. Effect measures comprised odds ratios (OR) for binary outcomes and standardized mean differences (SMD) for continuous outcomes, accompanied by 95% confidence intervals (CI), with heterogeneity evaluated using I 2 statistics. Results: Dobutamine was associated with higher in-hospital mortality (OR 1.56, 95% CI 1.01-2.39; I 2 = 93%; p = 0.04), which was non-significant in RCTs (OR 1.24, 95% CI 0.70-2.19; I 2 = 0%; p = 0.46; moderate certainty) but significant in observational studies (OR 1.63, 95% CI 1.02-2.59; I 2 = 94%; p = 0.04; very low certainty). Mortality was markedly increased in ICU settings (OR 2.85, 95% CI 1.42-5.69; I 2 = 93%; p I 2 = 84%; low certainty). Overall all-cause mortality was also higher with dobutamine (OR 1.54, 95% CI 1.07-2.21; I 2 = 87%; p = 0.02), remaining non-significant in RCT data (OR 1.30, 95% CI 0.73-2.32; moderate certainty) but significant in observational data (OR 1.58, 95% CI 1.06-2.35; I 2 = 89%; low certainty). No significant differences were observed in ICU length of stay (SMD -0.13, 95% CI -0.99 to 0.73; I 2 = 93%) or hospital length of stay (SMD -0.69, 95% CI -4.49 to 3.11; I 2 = 98%), and significant arrhythmias were comparable (OR 0.88, 95% CI 0.40-1.93; I 2 = 76%). However, acute renal failure was significantly more frequent with dobutamine (OR 1.22, 95% CI 1.01-1.47; I 2 = 0%; p = 0.03). Conclusion: Dobutamine is associated with increased mortality particularly in ICU patients and a higher risk of acute renal failure compared with milrinone, with evidence certainty ranging from moderate to very low and substantial heterogeneity across mortality outcomes.

Abstract licence: CC BY