Primacor question

i don't want to give the whole answer away (cause i think this is an important thing for you to know, and the best way to learn is to look it up in any up-to-date critical care textbook in the chapter regarding cardiac surgery).... but the bottom-line: the heart post-pump is cold, is undergoing some level of reperfusion-injury, and sometimes the cardioplegia wasn't perfect and you might have some damaged myocardium, the list goes on and on...

however, i would say it is not the norm to send patients to the ICU on milrinone - because most of them don't really need it... they usually start needing it after the honeymoon period usually 12 to 24 hours post-pump because of changes in ventricular compliance.

Although I don't work in CVICU, I would say the reason for the loading dose would be to help the heart come off pump. It would increase contractility and dilate vascular smooth muscle without increasing HR or myocardial oxygen consumption. Am I on the right track??

it isn't often that you need milrinone to come off pump --- usually it is a volume/tone thing way before it is a contractility thing...

hello

Nitecap...

I agree fully with you --- there is more and more literature to support the use of an inotrope in patients with EF<40% (especially older hearts > 55years)... In fact, I think milrinone is a wonderful drug...

but even in those patients, you can come off the pump pretty easily with good tone and good volume management and pacing, without the use of an inotrope.... Lately I have been doing 3 CABGs/Valves/Asc. Aortas per day and i would say I start milrinone coming off-pump on every 6-8th patient (and these people are pretty sick) - and I am at a major teaching hospital.

but in totum, i agree with your prediction....