A232 Intravenous milrinone for prevention of delayed cerebral ischemia in aneurismatic subarachnoid hemorrhage

<h3>Introduction</h3> Aneurysmal subarachnoid hemorrhage (aSAH) is a cause of severe brain injury. In patients who survive the initial rupture, vasospasm and delayed cerebral ischemia (DCI) have been established as markers of morbidity and mortality. <h3>Aim of study</h3> To evaluate the potential benefit of intravenous (IV) milrinone as a preventive strategy for delayed cerebral ischemia (DCI) following aSAH, and to assess its impact on functional outcomes and mortality. <h3>Method</h3> We conducted a retrospective cohort study in Colombia on patients with aSAH treated with aneurysm embolization. Patients were divided 2:1 into standard care and standard care plus IV milrinone groups. Outcomes assessed included functional status (mRS ≤3) at discharge and 90 days, mortality, vasospasm, and DCI. Subgroup analysis evaluated milrinone tolerance, need for rescue angioplasty, and infectious complications. <h3>Results</h3> Among 94 patients, 33 received IV milrinone in addition to standard care; 27.2% did not tolerate it due to hypotension or arrhythmia. Functional outcomes (mRS≤3) were similar between milrinone and control groups at discharge (54.2% vs 59.1%) and 90 days (62.5% vs 60.5%). However, patients with good milrinone tolerance had significantly better outcomes than those without tolerance (54.2% vs 11.1%, p=0.001). DCI was more frequent in the no-milrinone and no-tolerance groups. Mortality was lower in the milrinone group (12.5% vs 26.7%), with significantly higher mortality in patients who did not tolerate milrinone (77.7% vs 12.5%, p=0.001), suggesting tolerance influences prognosis. <h3>Conclusion</h3> In our study we found that prophylactic treatment with IV milrinone in patients with aSAH was associated with lower occurrence of DCI and lower mortality rates. <h3>Conflict of Interest</h3> No