What question did this study set out to answer?

To assess the efficacy and safety of prophylactic postoperative milrinone in preventing low cardiac output syndrome and mortality in pediatric patients undergoing corrective surgery for congenital heart disease.

March 25, 2015Cochrane libraryOpen Access

Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease

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Authors

BBBarbara BurkhardtUniversity Children's Hospital Zurich GRGerta RückerUniversity Medical Center Freiburg BSBrigitte StillerUniversitäts-Herzzentrum Freiburg-Bad Krozingen

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Implication

Systematic review reveals uncertain benefits of prophylactic milrinone for low cardiac output syndrome in pediatric cardiac surgery, indicating a need for higher-quality evidence.

Key Points

To assess the efficacy and safety of prophylactic postoperative milrinone in preventing low cardiac output syndrome and mortality in pediatric patients undergoing corrective surgery for congenital heart disease.
Systematic review of randomized controlled trials identified via CENTRAL, MEDLINE, EMBASE, and Web of Science through September 2014, with no language restrictions.
Included 5 randomized trials comprising 393 pediatric participants up to 12 years of age, evaluating milrinone versus levosimendan (3 trials, n=101), placebo (1 trial, n=242), or dobutamine (1 trial, n=50).
In a single placebo-controlled trial, prophylactic milrinone reduced the risk of low cardiac output syndrome (RR 0.52, 95% CI 0.28 to 0.96; n=227), whereas pooled data comparing milrinone to levosimendan were inconclusive (RR 1.22, 95% CI 0.32 to 4.65; n=59).
Mortality across trials was very low, providing insufficient evidence to determine differences between milrinone and placebo, levosimendan, or dobutamine regarding mortality, mechanical ventilation duration, or intensive care stay.
Milrinone demonstrated no significant differences compared to placebo in adverse outcomes, including arrhythmias (RR 3.59, 95% CI 0.83 to 15.42; n=238), pleural effusions (RR 1.78, 95% CI 0.92 to 3.42; n=231), or thrombocytopenia (RR 0.86, 95% CI 0.39 to 1.88; n=238).

Cite This Study

Burkhardt et al. (2015) studied this question.

synapsesocial.com/papers/6a88ff0a10247adea528aa30 https://doi.org/10.1002/14651858.cd009515.pub2

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Implication

Systematic review reveals uncertain benefits of prophylactic milrinone for low cardiac output syndrome in pediatric cardiac surgery, indicating a need for higher-quality evidence.

Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease

Discussion

Member takes

Implication

Key Points

Cite This Study

Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease

Discussion

Member takes

Implication

Key Points

Cite This Study

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