Key result
Early milrinone infusion without a loading dose during the Fontan procedure significantly improved cardiac index and arterial oxygen saturation, and decreased central venous pressure compared to a late loading dose regimen.
Why the study?
Does early milrinone infusion without a loading dose improve postoperative hemodynamics and oxygen saturation compared to late milrinone with a loading dose in pediatric patients undergoing the Fontan procedure?
RCT (n=116)
Double-blind
Random numbers generated through excel
Yes
Does early milrinone infusion without a loading dose improve postoperative hemodynamics and oxygen saturation compared to late milrinone with a loading dose in pediatric patients undergoing the Fontan procedure?
p-value: p=<0.05
Early milrinone infusion without a loading dose at the start of cardiopulmonary bypass improves hemodynamics, oxygenation, and facilitates weaning from bypass compared to late administration with a loading dose in pediatric patients undergoing the Fontan procedure.
May support early milrinone without loading in Fontan; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVE: The aim of the study was to compare the effect of two different regimens of milrinone on hemodynamics and oxygen saturation in pediatric patients undergoing Fontan procedure. DESIGN: This was a randomized study. SETTING: Cardiac centers. PATIENTS: This study included 116 patients undergoing Fontan procedure. MATERIAL AND METHODS: Group E: Milrinone was started as infusion 0.5 μg/kg/min without a loading dose at the beginning of cardiopulmonary bypass (CPB) followed by infusion 0.5-0.75 μg/kg/min in the pediatric cardiac surgical intensive care unit (PSICU). Group L: Milrinone was started as a loading dose 50 μg/kg over 10 min before weaning from CPB followed by infusion 0.5-0.75 μg/kg/min in the PSICU. MEASUREMENTS: Heart rate, mean arterial blood pressure, central venous pressure, transpulmonary pressure, cardiac index, pharmacological support, lactate level, urine output, oxygen saturation, ICU, and hospital length of stay. MAIN RESULTS: There were no changes in the heart rate and mean arterial blood pressure (P > 0.05). The increase in the postoperative central venous pressure, transpulmonary pressure and lactate level was lower in Group E than Group L (P < 0.05). The increase in the postoperative cardiac index, oxygen saturation, and urine output was higher in Group E than Group L (P < 0.05). The requirement for pharmacological support was lower in the Group E (P < 0.05). The ICU and hospital length of stay were shorter in the Group E than Group L (P < 0.05). CONCLUSION: Early use of milrinone during Fontan procedure facilitated the weaning from CPB, decreased the elevation in the central venous pressure, transpulmonary gradient pressure, and the requirement for pharmacological support. Furthermore, it increased the cardiac index and arterial oxygen saturation.
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Soliman et al. (2018) conducted an RCT in Pediatric patients undergoing Fontan procedure (n=116). Early milrinone infusion vs. Late milrinone (50 µg/kg loading dose before CPB weaning, followed by 0.5-0.75 µg/kg/min infusion) was evaluated on Postoperative hemodynamic stability (central venous pressure, transpulmonary pressure gradient, cardiac index, arterial oxygen saturation) (p=<0.05). Early milrinone infusion without a loading dose during the Fontan procedure significantly improved cardiac index and arterial oxygen saturation, and decreased central venous pressure compared to a late loading dose regimen.
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