• Lisa Q Rong, Mohamed Rahouma, Ahmed Abouarab, Antonino Di Franco, Nicole M Calautti, Meghann M Fitzgerald, Mohammed J Arisha, Dina A Ibrahim, Leonard N Girardi, Kane O Pryor, and Mario Gaudino.
• Department of Anesthesiology, Weill Cornell Medicine, New York, NY. Electronic address: lir9065@med.cornell.edu.
• J. Cardiothorac. Vasc. Anesth. 2019 Mar 1; 33 (3): 663-673.

ObjectiveTo summarize the evidence on the hemodynamic, echocardiographic, and clinical effects of inhaled and intravenous milrinone (iMil and IvMil) in adult cardiac surgery patients.DesignSystematic review, pairwise and network meta-analysis.SettingMulti-institutional.ParticipantsAdult cardiac surgery patients.InterventionsComparison between iMil and IvMil versus other agents or placebo.Measurements And Main ResultsThe primary endpoints were mean pulmonary artery pressure (MPAP) and peripheral vascular resistance (PVR). Secondary endpoints included the following: (1) mean arterial pressure, heart rate, and cardiac index (CI); (2) echocardiographic data; and (3) clinical outcomes. Random model, leave-one-out-analysis, and meta-regression were used. Thirty studies (6 iMil and 24 IvMil) were included for a total of 1,438 patients (194 iMil and 521 IvMil). IvMil was associated with a lower MPAP, lower PVR, and higher CI compared to placebo (standardized mean difference [SMD] = -0.22 [95% CI = -0.48 to 0.05], SMD = -0.49 [95% CI = -0.71 to -0.27], and SMD = 0.94 [95% CI = 0.51 to 1.37]). No difference in any outcome was found between iMil and placebo. At network meta-analysis, significantly lower PVR and shorter hospital length of stay were found for IvMil compared to iMil (SMD = -0.82 [95% CI = -1.53 to -0.10] and SMD = -0.50 [95% CI = -0.95 to -0.05], respectively).ConclusionThese results support the clinical use of IvMil in cardiac surgery patients. No evidence at present supports the adoption of iMil.Copyright © 2018 Elsevier Inc. All rights reserved.

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