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28.07.2016 | Reports of Original Investigations | Ausgabe 10/2016

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 10/2016

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

Canadian Journal of Anesthesia/Journal canadien d'anesthésie > Ausgabe 10/2016
MD, PhD André Y. Denault, MD Jean S. Bussières, MD Ramiro Arellano, MD Barry Finegan, PhD Paul Gavra, MD François Haddad, PhD Anne Q. N. Nguyen, PhD France Varin, MSc Annik Fortier, MSc Sylvie Levesque, MD Yanfen Shi, MSc Mahsa Elmi-Sarabi, MD Jean-Claude Tardif, MD, PhD Louis P. Perrault, PhD Jean Lambert
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s12630-016-0709-8) contains supplementary material, which is available to authorized users.
This article is accompanied by an editorial. Please see Can J Anesth 2016; 63: this issue.



Inhaled milrinone (iMil) has been used for the treatment of pulmonary hypertension (PH) but its efficacy, safety, and prophylactic effects in facilitating separation from cardiopulmonary bypass (CPB) and preventing right ventricular (RV) dysfunction have not yet been evaluated in a clinical trial. The purpose of this study was to investigate if iMil administered before CPB would be superior to placebo in facilitating separation from CPB.


High-risk cardiac surgical patients with PH were randomized to receive iMil or placebo after the induction of anesthesia and before CPB. Hemodynamic parameters and RV function were evaluated by means of pulmonary artery catheterization and transesophageal echocardiography. The groups were compared for the primary outcome of the level of difficulty in weaning from CPB. Among the secondary outcomes examined were the reduction in the severity of PH, the incidence of RV failure, and mortality.


Of the 124 patients randomized, the mean (standard deviation [SD]) EuroSCORE II was 8.0 (2.6), and the baseline mean (SD) systolic pulmonary artery pressure (SPAP) was 53 (9) mmHg. The use of iMil was associated with increases in cardiac output (P = 0.03) and a reduction in SPAP (P = 0.04) with no systemic hypotension. Nevertheless, there was no difference in the combined incidence of difficult or complex separation from CPB between the iMil and control groups (30% vs 28%, respectively; absolute difference, 2%; 95% confidence interval [CI], −14 to 18; P = 0.78). There was also no difference in RV failure between the iMil and control groups (15% vs 14%, respectively; difference, 1%; 95% CI, −13 to 12; P = 0.94). Mortality was increased in patients with RV failure vs those without (22% vs 2%, respectively; P < 0.001).


In high-risk cardiac surgery patients with PH, the prophylactic use of iMil was associated with favourable hemodynamic effects that did not translate into improvement of clinically relevant endpoints. This trial was registered at; identifier: NCT00819377.

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