Abstract TMP101: Safety and Outcome of High Doses IV Milirinone in Subarachnoid Hemorrhage With Refractory Vasospasm
Bibliographic record
Abstract
Introduction: Vasospasm causing delayed cerebral ischemia (DCI) remains a leading cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). Our previously reported series detailed the safety and efficacy of cardiac doses of milrinone in DCI. Since 2007, we have been treating refractory delayed cerebral ischemia (RDCI) with very large doses of IV milrinone. We report the safety and clinical effect of high-dose milrinone in aSAH with RDCI. Methods: Retrospective single center analysis of all patients treated between October 2014 and July 2015 for vasospasm refractory to the MNH protocol (RDCI). RDCI patients received a bolus and perfusion that were increased incrementally until resolution of signs. If 2 boluses and 2 increases in perfusion were unsuccessful, patients underwent angiogram for intra-arterial (IA) milrinone and possible angioplasty. Results: 40 patients were admitted for acute aSAH. Vasospasm was diagnosed clinically in 26 (65%). Initial milrinone therapy included a loading dose of 6 mg and an infusion of 0.75 mcg/kg/min. Of these patients, 18 had RDCI and received boluses of up to 8mg IV with perfusions of up to 2.75 mcg/kg/min. The maximum cumulative daily dose of milrinone was 230mg. There were no adverse cardiovascular events due to the drug. Neurologic improvement was seen in 8/18 with large IV bolus and perfusion of milrinone. Ten patients required angiography; all received IA milrinone, and angioplasty was performed in 3. Modified rankin scale (mRS) ≤ 2 on discharge was achieved in 6 of the 8 patients who improved with high-dose IV milrinone alone, 2 of 3 patients undergoing angioplasty and 4 of the 7 patients receiving IA milrinone without angioplasty. Conclusion: High doses of IV milrinone were effective in a large proportion of our patients with vasospasm and RDCI after aSAH, and it was extremely safe. This treatment could be considered prior to angioplasty.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".