title: The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review.
abstract: OBJECTIVE
  The purpose of this article is to provide a systematic review of the evidence supporting the use of milrinone for the management of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH).
  
  
  METHODS
  Primary outcomes were functional neurological status and the incidence of cerebral infarction. Search strategies adapted to the different databases were developed by a professional librarian. Medline, EMBASE, the Cochrane Library database, Web of Science, SCOPUS, BIOSIS, Global Health, Health Star, Open SIGLE, Google Scholar and the New York Academy of Medicine Gray Literature were searched as well as clinical trials databases and the proceedings of several scientific meetings. Quality of the evidence for these outcomes across studies was adjudicated using the GRADE Working Group criteria.
  
  
  RESULTS
  The search resulted in 284 citations after elimination of duplicates. Of those 9 conference proceedings and 15 studies met inclusion criteria and consisted of case reports, case series and two comparative studies: one non-randomized study with physiological outcomes only and a case series with historical controls. There was considerable variation in dosing and in co-interventions and no case control or randomized controlled studies were found.
  
  
  CONCLUSIONS
  There is currently only very low quality evidence to support the use of milrinone to improve important outcomes in patients with delayed cerebral ischemia secondary to subarachnoid hemorrhage. Further research is needed to clarify the value and risks of this medication in patients with SAH.
authors.affiliation: 1McGill University,Department of Anesthesiology,Montreal Neurological Hospital,Montreal,Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Lannes
authors.affiliation: 2Section of Neurosurgery,University of Manitoba,Winnipeg,Manitoba,Canada.
authors.forename: Frederick
authors.initials: F
authors.lastname: Zeiler
authors.affiliation: 3Department of Anesthesiology and Critical Care Medicine,Croix Rousse Hospital,Lyon,France.
authors.forename: Céline
authors.initials: C
authors.lastname: Guichon
authors.affiliation: 4McGill University,Department of Neurology,Montreal Neurological Hospital,Montreal,Canada.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Teitelbaum
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D020105:Milrinone / Q000627:therapeutic use*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D020105:Milrinone
keywords: Cerebral vasospasm; delayed ischemia milrinone; subarachnoid hemorrhage