Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study.,Journal of Cardiothoracic and Vascular Anesthesia

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Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study.
Journal of Cardiothoracic and Vascular Anesthesia ( IF 2.3 ) Pub Date : 2020-05-21 , DOI: 10.1053/j.jvca.2020.04.006
Eduardo A Osawa ₁ , Salvatore L Cutuli ₂ , Luca Cioccari ₃ , Laurent Bitker ₄ , Leah Peck ₄ , Helen Young ₄ , Lara Hessels ₅ , Fumitaka Yanase ₆ , Julia T Fukushima ₇ , Ludhmila A Hajjar ₇ , Siven Seevanayagam ₈ , George Matalanis ₈ , Glenn M Eastwood ₄ , Rinaldo Bellomo ₉

Affiliation

Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Cardiology, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli, Universita Cattolica del Sacro Cuore, Rome, Italy.
Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland.
Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Groningen, University Medical Center, Groningen, The Netherlands.
Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia.
Department of Cardiology, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Department of Cardiac Surgery, Austin Hospital, Heidelberg, Melbourne, Australia.
Department of Intensive Care, Austin Hospital, Melbourne, Australia; Centre for Integrated Critical Care, School of Medicine, The University of Melbourne, Melbourne, Australia.

Objective

The authors aimed to test whether a bolus of magnesium followed by continuous intravenous infusion might prevent the development of atrial fibrillation (AF) after cardiac surgery.

Design

Sequential, matched, case-controlled pilot study.

Setting

Tertiary university hospital.

Participants

Matched cohort of 99 patients before and intervention cohort of 99 consecutive patients after the introduction of a continuous magnesium infusion protocol.

Interventions

The magnesium infusion protocol consisted of a 10 mmol loading dose of magnesium sulphate followed by a continuous infusion of 3 mmol/h over a maximum duration of 96 hours or until intensive care unit discharge.

Measurements and Main Results

The study groups were balanced except for a lower cardiac index in the intervention cohort. The mean duration of magnesium infusion was 27.93 hours (95% confidence interval [CI]: 24.10-31.76 hours). The intervention group had greater serum peak magnesium levels: 1.72 mmol/L ± 0.34 on day 1, 1.32 ± 0.36 on day 2 versus 1.01 ± 1.14 and 0.97 ± 0.13, respectively, in the control group (p < 0.01). Atrial fibrillation occurred in 25 patients (25.3%) in the intervention group and 40 patients (40.4%) in the control group (odds ratio 0.49, 95% CI, 0.27-0.92; p = 0.023). On a multivariate Cox proportional hazards model, the hazard ratio for the development of AF was significantly less in the intervention group (hazard ratio 0.45, 95% CI, 0.26-0.77; p = 0.004).

Conclusion

The magnesium delivery strategy was associated with a decreased incidence of postoperative AF in cardiac surgery patients. These findings provide a rationale and preliminary data for the design of future randomized controlled trials.

中文翻译：

连续镁输注预防心脏外科手术后房颤的发生：一项连续的病例对照研究。

目的

作者的目的是测试大剂量的镁然后连续静脉输注是否可以预防心脏手术后房颤的发生。

设计

顺序，匹配，病例对照的试验研究。

设置

大专医院。

参加者

引入连续镁输注方案之前，有99名患者的配对队列和有99名连续患者的干预队列。

干预措施

镁输注方案包括10毫克负荷剂量的硫酸镁，然后在最长96小时内或直至重症监护病房出院前连续输注3毫摩尔/小时。

测量和主要结果

除干预组的心脏指数较低外，研究组保持平衡。镁的平均输注时间为27.93小时（95％置信区间[CI]：24.10-31.76小时）。干预组的血镁峰值更高：第1天为1.72 mmol / L±0.34，第2天为1.32±0.36，而对照组分别为1.01±1.14和0.97±0.13（p <0.01）。干预组有25名患者（25.3％）和对照组有40名患者（40.4％）发生房颤（优势比为0.49、95％CI，0.27-0.92； p = 0.023）。在多变量Cox比例风险模型中，干预组房颤发生的风险比显着降低（风险比0.45、95％CI，0.26-0.77； p = 0.004）。