Comparison of the hemodynamic effects of milrinone with dobutamine in patients after cardiac surgery.

Abstract

OBJECTIVE:

To compare the hemodynamic effects, efficacy, and safety of intravenous milrinone (M), 50 microg/kg during 10 minutes followed by 0.5 microg/kg/min, with intravenous dobutamine (D), 10 to 20 microg/kg/min, in patients with low cardiac output after cardiac surgery.

DESIGN:

Randomized, open-label, multicenter study.

SETTING:

Cardiothoracic surgery departments, operating rooms, and intensive care units in 6 university hospitals.

PARTICIPANTS:

Patients (n = 120; 60 per group) after elective cardiac surgery.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Analysis compared the hemodynamics at baseline and the percentage change from baseline during 4 hours of the drug infusion. The incidence of adverse events was recorded. Both groups had low mean (+/- SEM) cardiac indices (M, 1.6 ([0.03] L/min/m(2); D, 1.7 [0.03] L/min/m(2)) in association with adequate mean pulmonary capillary wedge pressures (M, 13.7 [1.3] mmHg; D, 12.7 [1.9] mmHg) at baseline. Group M had significantly higher systemic arterial pressures and systemic vascular resistances compared with group D; otherwise, the hemodynamics in both groups were comparable. During the study, hemodynamic responses included the following: group D had greater increases in cardiac index (at 1 hour, D = 55%, M = 36%; p < 0.01), heart rate (at 1 hour, D = 35%, M = 10%; p < 0.001), arterial pressures (mean arterial pressure at 1 hour, D = 31%, M = 7%; p < 0.001), and left ventricular stroke work index (at 1 hour, D = 75%, M = 45%; p < 0.05). Group M had greater decreases in mean pulmonary capillary wedge pressure (at 1 hour, D = -3%, M = -14%; p < 0.05). Comparisons of adverse events showed that dobutamine was associated with a higher incidence of hypertension (D = 40%, M = 13%; p < 0.02) and change of rhythm from sinus to atrial fibrillation (D = 18%, M = 5%; p < 0.04). Milrinone was associated with a higher incidence of sinus bradycardia (D = 2%, M = 13%; p < 0.03).

CONCLUSIONS:

Milrinone and dobutamine are appropriate and comparable for the pharmacologic treatment of the low- output syndrome after cardiopulmonary bypass.

• Authors: R O Feneck, K M Sherry, P S Withington, A Oduro-Dominah, European Milrinone Multicenter Trial Group
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 15 Issue 3 Pg. 306-15 (Jun 2001) ISSN: 1053-0770 [Print] United States
• PMID: 11426360 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2001 by W.B. Saunders Company.

Chemical References

• Adrenergic beta-Agonists
• Dobutamine
• Milrinone

Topics

• Adrenergic beta-Agonists (adverse effects, pharmacology, therapeutic use)
• Blood Gas Analysis
• Cardiac Output, Low (physiopathology)
• Cardiac Surgical Procedures
• Dobutamine (adverse effects, pharmacology, therapeutic use)
• Female
• Hemodynamics (drug effects)
• Humans
• Hypertension, Pulmonary (physiopathology)
• Hypotension (physiopathology)
• Male
• Middle Aged
• Milrinone (adverse effects, pharmacology, therapeutic use)
• Postoperative Period