WJCD  Vol.5 No.11 , November 2015
The Risk of Milrinone Use in Severe Neurological Insult and Stunned Myocardium
ABSTRACT
Acute neurological injuries cause catecholamine-induced cardiac damage and can result in or ex-acerbate preexisting cardiac failure. Milrinone (primacor) has been effective in the treatment of cardiac failure as well as cerebral vasospasm. We would like to present the outcomes of milrinone use in patients with major neurological injuries and preexisting compromised myocardial function. Four patients, age < 60 y/old, three women (two postpartum) and one man, will be presented. Two were diagnosed with a subarachnoid hemorrhage (SAH) coupled with severe vasospasm; one had status epilepticus (SE); and one had cerebral ischemia (CVA) due to carotid artery occlusion. All patients had cardiomyopathy with EF < 35%. All patients were on at least one press or prior to being put on milrinone. Three out of the four patients required an increase in norepinephrine or additional pressors after milrinone was added. All of the patients developed tachycardia, three severe and one mild. In two patients milrinone had to be discontinued due to the persistent hypotension. In our experience, use of milrinone drip in patients with preexisting cardiomyopathy led to hypotension and tachycardia, and brought about the need to increase or add new pressors, which in turn exacerbated catecholamine-induced myocardial injury.

Cite this paper
Wirkowski, E. , Kocztorz, L. , Hanna, A. , Christiansen, C. and Bielawski, N. (2015) The Risk of Milrinone Use in Severe Neurological Insult and Stunned Myocardium. World Journal of Cardiovascular Diseases, 5, 307-312. doi: 10.4236/wjcd.2015.511035.
References
[1]   Lannes, M., Teitelbaum, J., Cortes, M. and Cardoso, M. (2002) Milrinone and Homeostasis to Treat Cerebral Vasospasm Associated with Subarachnoid Hemorrhage: The Montreal Neurological Hospital Protocol. Neurocritical Care, 16, 354-362.
http://dx.doi.org/10.1007/s12028-012-9701-5

[2]   Fraticelli, A., Cholley, B.P., Losser, M.-R., et al. (2008) Milrinone for the Treatment of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage. Stroke, 39, 893-898.
http://dx.doi.org/10.1161/STROKEAHA.107.492447

[3]   Naidech, A., Du, Y., Kreter, K., et al. (2005) Dobutamine versus Milrinone after SAH. Neurosurgery, 56, 21-27.

[4]   Burkhardt, B.E., Rucker, G. and Stiller, B. (2015) Prophylactic Milrinone for the Prevention of Low Cardiac Output Syndrome and Mortality in Children Undergoing Surgery for Congenital Heart Disease. Cochrane Database of Systematic Reviews, 3, CD009515.
http://dx.doi.org/10.1002/14651858.cd009515.pub2

[5]   Sherif, C., Wambacher, B., Loyoddin, M., Karaic, R., et al. (2014) Repeated Combined Endovascular Therapy with Milrinone and Nimodipine for the Treatment of Severe Vasospasm: Preliminary Results. Neurovascular Events after Subarachnoid Hemorrhage, Acta Neurochirurgica Supplement, 120, 203-207.

[6]   Shankar, J.J., dos Santos, M.P., Deus-Silva, L. and Lum, C. (2011) Angiographic Evaluation of the Effect of Intra-Arterial Milrinone Therapy in Patients with Vasospasm from Aneurysmal Subarachnoid Hemorrhage. Neuroradiology, 53, 123-128.
http://dx.doi.org/10.1007/s00234-010-0720-7

[7]   Sadamasa, N., Narumi, K.Y.O., Chin, M. and Yama-gata, S. (2014) Milrinone via Lumbar Subarachnoid Catheter for Vasospasm after Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care, 21, 470-475.
http://dx.doi.org/10.1007/s12028-014-9996-5

[8]   Zeiler, F.A., Silvaggio, J., Kauf-mann, A.M., Gillman, L.M. and West, M. (2014) Norepinephrine as a Potential Aggravator of Symptomatic Cerebral Vaso-spasm: Two Cases and Argument for Milrinone Therapy. Case Reports in Critical Care, 2014, Article ID: 630970.
http://dx.doi.org/10.1155/2014/630970

 
 
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