The effect of intravenous milrinone in adult critically ill patients: a meta-analysis of randomized clinical trials

Background Milrinone is widely used for enhancing myocardial contractility, however, there is inadequate data to suggest it is preferable to other inotropic agents. To observe the effect of milrinone on prognosis in adult critically ill patients, we conducted this meta-analysis. Methods A search of the following databases was conducted: Medline, Elsevier, Cochrane Central Register of Controlled Trials and Web of Science databases, and eligible randomized controlled trials including adult critically ill patients were screened. Two reviewers collected data separately, information was retrieved including study design, center number, sample size, gender, age, intervention and outcome. Data were analyzed using methods recommended by the Cochrane Collaboration Review Manager 4.2 software. Random errors were evaluated by trial sequential analysis (TSA). Results Twenty studies including 2036 patients compared milrinone with control group were enrolled. When compared to control group, the incidence of ventricular arrhythmia decreased significantly in milrinone group in patients with cardiac surgery, but not in patients with cardiac dysfunction and shock. There was no significant reduction in the incidence of myocardial infarction, all-cause mortality and no improvement of hemodynamic paramenters in the milrinone group. TSA indicated lack of firm evidence for a beneficial effect. Conclusions The meta-analysis showed when compared with control group, the incidence of ventricular arrhythmia decreased significantly in patients with cardiac surgery, but not in patients with cardiac dysfunction and shock who applying milrinone, while there was no significant reduction in the incidence of myocardial infarction, all-cause mortality and no improvement of hemodynamics.