Ro. Feneck et al., Comparison of the hemodynamic effects of milrinone with dobutamine in patients after cardiac surgery, J CARDIOTHO, 15(3), 2001, pp. 306-315
Objective: To compare the hemodynamic effects, efficacy, and safety of intr
avenous milrinone (M), 50 mug/kg during 10 minutes followed by 0.5 mug/kg/m
in, with intravenous dobutamine (D), 10 to 20 mug/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 surge
ry.
Interventions: None.
Measurements and Main Results: Analysis compared the hemodynamics at baseli
ne and the percentage change from baseline during 4 hours of the drug infus
ion. 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 NI had signific
antly higher systemic arterial pressures and systemic Vascular resistances
compared with group D; otherwise, the hemodynamics in both groups were comp
arable. During the study, hemodynamic responses included the following: gro
up 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 pre
ssures (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 show
ed 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 fibri
llation (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 th
e pharmacologic treatment of the low-output syndrome after cardiopulmonary
bypass. Copyright (C) 2001 by W.B. Saunders Company.