Intravenous administration of Milrinone, as an alternative approach to treat vasospasm in subarachnoid hemorrhage: A case report of transcranial Doppler monitoring

Abstract

Key Clinical Message This case illustrates the importance and potential of having TCD monitoring in intensive care. This easy‐to‐use, safe, low‐cost, and bedside tool allows evaluation of the safety and feasibility of an alternative treatment of VSP in SCH and demonstrates the potential to avoid the use of angiography, a high cost, invasive procedure.

Efficacy and safety of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage: a systematic review

“…Of the 22 studies eligible for review, ( 1 , 5 , 14 , 16 , 22 - 39 ) six illustrated non-controlled observational retrospective studies, ( 14 , 30 , 32 - 35 ) 14 were non-controlled observational prospective studies, ( 1 , 5 , 16 , 22 - 29 , 36 - 38 ) one was a controlled observational retrospective study ( 31 ) and only one was a randomized controlled trial (RCT). ( 39 ) All were single-center studies.…”

“…In most studies, the Fisher scale and Hunt & Hess scale were used to evaluate patients. Subarachnoid hemorrhage grade by the Fisher scale was described in 19 studies, ( 1 , 5 , 14 , 16 , 22 - 29 , 31 , 33 , 34 , 36 - 39 ) and 18 of those studies ( 1 , 5 , 14 , 16 , 23 - 29 , 31 , 33 , 34 , 36 - 39 ) included patients presenting moderate to severe subarachnoid hemorrhage (Fisher 3 - 4).…”

“…Three studies including 95 patients used the intra-arterial route for administration of milrinone, ( 1 , 14 , 32 ) and nine other studies including 174 patients were conducted using intravenous administration. ( 22 , 25 - 28 , 30 , 36 , 38 , 39 ) In six other studies, milrinone was administered by both routes. ( 5 , 16 , 23 , 24 , 33 , 37 ) Two studies used the intrathecal route, ( 31 , 35 ) one used the cisternal route ( 34 ) and the last study did not mention the administration route.…”

“…The screening tool for vasospasm differed from the diagnostic tool in many studies. Patients were screened by serial transcranial Doppler (TCD) in eleven of the studies, ( 1 , 5 , 14 , 27 , 29 , 30 , 32 , 36 - 39 ) by angiography in five studies, ( 20 , 23 , 24 , 33 , 35 ) by angiography or TCD in two studies ( 16 , 28 ) and by computed tomography (CT) angiography in one study. ( 25 ) Different methods were used for diagnosis.…”

Intensive care management of arterial carbon dioxide in acute intracerebral haemorrhage: Case report of influences on cerebral haemodynamics

“…8 This case corroborates previous reports of the many benefits of having TCD available in the ICU as an easy-to-use, safe, and lowcost bedside tool. 11,12 This tool allowed us not only to observe changes in CBFV but also monitor CA at the bedside. Although the CA was normal 24 hours after the admission and critical care treatment, other variables, such as PaCO 2 , can modify CA and it may have a subsequent impact on the patient's clinical outcome.…”