title: Impact of Milrinone Administration in Adult Cardiac Surgery Patients: Updated Meta-Analysis.
abstract: OBJECTIVE
  To determine the effects of milrinone on short-term mortality in cardiac surgery patients with focus on the presence or absence of heterogeneity of the effect.
  
  
  METHODS
  A systematic review and meta-analysis.
  
  
  METHODS
  Five hundred thirty-seven adult cardiac surgery patients from 12 RCTs.
  
  
  METHODS
  Milrinone administration.
  
  
  RESULTS
  The authors conducted a systematic Medline and Pubmed search to assess the effect of milrinone on short-term mortality in adult cardiac surgery patients. Subanalysis was performed according to the timing for commencement of milrinone administration and the type of comparators. The primary outcome was any short-term mortality. Overall analysis showed no difference in mortality rates in patients who received milrinone and patients who received comparators (odds ratio = 1.25, 95% CI 0.45-3.51, p = 0.67). In subanalysis for the timing to commence milrinone administration and the type of comparators, odds ratio for mortality varied from 0.19 (placebo as control drug, start of administration after cardiopulmonary bypass) to 2.58 (levosimendan as control drug, start of administration after cardiopulmonary bypass).
  
  
  CONCLUSIONS
  Among RCTs to assess the effect of milrinone administration in adult cardiac surgery patients, there are wide variations of the odds ratios of administration of milrinone for short-term mortality according to the comparators and the timing of administration. This fact may suggest that a simple pooling meta-analysis is not applicable for assessing the risk and benefit of milrinone administration in an adult cardiac surgery cohort.
authors.affiliation: Department of Anesthesia, Kakogawa West City Hospital, Kakogawa City, Hyogo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ushio
authors.affiliation: Department of Anesthesiology, Kobe University Hospital, Kobe City, Hyogo, Japan. Electronic address: moriori@tg8.so-net.ne.jp.
authors.forename: Moritoki
authors.initials: M
authors.lastname: Egi
authors.affiliation: Department of Anesthesiology, Kobe University Hospital, Kobe City, Hyogo, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Wakabayashi
authors.affiliation: Department of Anesthesiology, Kobe University Hospital, Kobe City, Hyogo, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe City, Hyogo 650-0017, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyatake
authors.affiliation: Department of Anesthesiology, Kobe University Hospital, Kobe City, Hyogo, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Obata
authors.affiliation: Department of Anesthesiology, Kobe University Hospital, Kobe City, Hyogo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mizobuchi
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D020105:Milrinone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D002316:Cardiotonic Agents; D020105:Milrinone
keywords: cardiac surgery; milrinone; mortality; outcomes