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Dobutamine versus Milrinone after Subarachnoid Hemorrhage

Naidech, Andrew M.D., M.S.P.H.; Du, Yunling Ph.D.; Kreiter, Kurt T. Ph.D.; Parra, Augusto M.D., M.P.H.; Fitzsimmons, Brian-Fred M.D.; Lavine, Sean D. M.D.; Connolly, E Sander M.D.; Mayer, Stephan A. M.D.; Commichau, Christopher M.D.

Neurosurgery:
doi: 10.1227/01.NEU.0000144780.97392.D7
Clinical Studies: CEREBROVASCULAR
Abstract

OBJECTIVE: Neurogenic stunned myocardium is a well-recognized complication of subarachnoid hemorrhage. Dobutamine and milrinone are both used for neurogenic stunned myocardium, but there are few data comparing them after subarachnoid hemorrhage.

METHODS: We compared the physiological dose response of dobutamine and milrinone in patients with subarachnoid hemorrhage requiring a pulmonary artery catheter. We located 11 patients who received either inotrope. Physiological data were fitted to a mixed model accounting for drug, dose, and between-patient variation.

RESULTS: There were 11 patients who had 152 pulmonary artery catheter measurements. Two received both inotropes (but not within 4 h of each other), 2 only milrinone, and 7 only dobutamine. The groups had similar clinical and physiological characteristics. After adjustment for vasopressin, milrinone was significantly more potent in increasing cardiac output (P < 0.0001) and stroke volume (P = 0.03), while decreasing vascular resistance (P < 0.0001) and systolic blood pressure (P = 0.008), than dobutamine.

CONCLUSION: These data suggest that milrinone and dobutamine should be used in different clinical situations. Milrinone may be more effective in patients with severely depressed systolic function but who have at least normal vascular resistance and blood pressure and in whom raising cardiac output is the primary goal. Dobutamine may be superior when vascular resistance or blood pressure is low.

Author Information

Department of Neurology, Columbia University, New York, New York (Naidech)

Department of Biostatistics, Columbia University, New York, New York (Du)

Department of Neurology, Columbia University, New York, New York (Kreiter)

Department of Neurology, Columbia University, New York, New York (Parra)

Department of Neurology, Columbia University, New York, New York (Fitzsimmons)

Department of Neurological Surgery, Columbia University, New York, New York (Lavine)

Department of Neurological Surgery, Columbia University, New York, New York (Connolly)

Department of Neurology, Columbia University, New York, New York (Mayer)

Department of Neurology, Columbia University, New York, New York (Commichau)

Reprint requests: Andrew Naidech, M.D., M.S.P.H., Department of Neurology and Critical Care, Northwestern University, 710 North Lake Shore Drive, 11th Floor, Chicago, IL 60611. Email: a-naidech@northwestern.edu

Received, May 24, 2004.

Accepted, August 27, 2004.

Copyright © by the Congress of Neurological Surgeons