Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage continues to be associated with high levels of morbidity and mortality. This complication had long been thought to occur secondary to severe cerebral vasospasm, but expert opinion now favors a multifactorial etiology, opening the possibility of new therapies. To date, no definitive treatment option for DCI has been recommended as standard of care, highlighting a need for further research into potential therapies. Milrinone has been identified as a promising therapeutic agent for DCI, possessing a mechanism of action for the reversal of cerebral vasospasm as well as potentially anti-inflammatory effects to treat the underlying etiology of DCI. Intra-arterial and intravenous administration of milrinone has been evaluated for the treatment of DCI in single-center case series and cohorts and appears safe and associated with improved clinical outcomes. Recent results have also brought attention to the potential outcome benefits of early, more aggressive dosing and titration of milrinone. Limitations exist within the available data, however, and questions remain about the generalizability of results across a broader spectrum of patients suffering from DCI. The development of a standardized protocol for milrinone use in DCI, specifically addressing areas requiring further clarification, is needed. Data generated from a standardized protocol may provide the impetus for a multicenter, randomized control trial. We review the current literature on milrinone for the treatment of DCI and propose a preliminary standardized protocol for further evaluation of both safety and efficacy of milrinone.

中文翻译：

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用米力农治疗蛛网膜下腔出血相关的迟发性脑缺血：回顾和建议。

动脉瘤性蛛网膜下腔出血后迟发性脑缺血（DCI）仍然与高发病率和死亡率相关。长期以来，这种并发症被认为是继发于严重脑血管痉挛的，但现在专家意见支持多因素病因，为新疗法开辟了可能性。迄今为止，尚未推荐 DCI 的明确治疗方案作为标准护理，这凸显了对潜在疗法进行进一步研究的必要性。米力农已被认为是一种有前景的 DCI 治疗剂，具有逆转脑血管痉挛的作用机制以及潜在的抗炎作用，可治疗 DCI 的潜在病因。动脉内和静脉内给予米力农治疗 DCI 的效果已在单中心病例系列和队列中进行了评估，显示出安全性并与改善临床结果相关。最近的结果也引起了人们对早期、更积极的米力农剂量和滴定的潜在结果益处的关注。然而，现有数据存在局限性，并且结果对于更广泛的 DCI 患者的普遍性仍然存在疑问。需要制定米力农在 DCI 中使用的标准化方案，特别是解决需要进一步澄清的领域。从标准化方案生成的数据可以为多中心、随机对照试验提供动力。我们回顾了米力农治疗 DCI 的现有文献，并提出了一个初步的标准化方案，以进一步评估米力农的安全性和有效性。