Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study
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Citações na Scopus
4
Tipo de produção
article
Data de publicação
2020
Título da Revista
ISSN da Revista
Título do Volume
Editora
W B SAUNDERS CO-ELSEVIER INC
Autores
CUTULI, Salvatore L.
CIOCCARI, Luca
BITKER, Laurent
PECK, Leah
YOUNG, Helen
HESSELS, Lara
YANASE, Fumitaka
Citação
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, v.34, n.11, p.2940-2947, 2020
Resumo
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.
Palavras-chave
magnesium, cardiac surgery, sequential matching, case-control, intensive care
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