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Title: Magnesium status and magnesium therapy in cardiac surgery: a systematic review and meta-analysis focusing on arrhythmia prevention
Austin Authors: Fairley, Jessica L;Zhang, Ling;Glassford, Neil J;Bellomo, Rinaldo 
Affiliation: Alfred Hospital, Prahran, Victoria, Australia
School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
Issue Date: Dec-2017
Date: 2017-06-21
Publication information: Journal of Critical Care 2017; 42: 69-77
Abstract: PURPOSE: To investigate magnesium as prophylaxis or treatment of postoperative arrhythmias in cardiac surgery (CS) patients. To assess impact on biochemical and patient-centered outcomes. MATERIALS AND METHODS: We searched MEDLINE, CENTRAL and EMBASE electronic databases from 1975 to October 2015 using terms related to magnesium and CS. English-Language RCTs were included involving adults undergoing CS with parenterally administered magnesium to treat or prevent arrhythmias, compared to control or standard antiarrythmics. We extracted incidence of postoperative arrhythmias, termination following magnesium administration and secondary outcomes (including mortality, length of stay, hemodynamic parameters, biochemistry). RESULTS: Thirty-five studies were included, with significant methodological heterogeneity. Atrial fibrillation (AF) was most commonly reported, followed by ventricular, supraventricular and overall arrhythmia frequency. Magnesium appeared to reduce AF (RR 0.69, 95% confidence interval (95%CI) 0.56-0.86, p=0.002), particularly postoperatively (RR 0.51, 95%CI 0.34-0.77, p=0.003) for longer than 24h. Maximal benefit was seen with bolus doses up to 60mmol. Magnesium appeared to reduce ventricular arrhythmias (RR=0.46, 95%CI 0.24-0.89, p=0.004), with a trend to reduced overall arrhythmias (RR=0.80, 95%CI 0.57-1.12, p=0.191). We found no mortality effect or significant increase in adverse events. CONCLUSIONS: Magnesium administration post-CS appears to reduce AF without significant adverse events. There is limited evidence to support magnesium administration for prevention of other arrhythmias.
DOI: 10.1016/j.jcrc.2017.05.038
Journal: Journal of Critical Care
PubMed URL:
Type: Journal Article
Subjects: Arrhythmia
Biochemical outcome
Critical illness
Electrolyte disturbance
Intensive care
Magnesium administration
Magnesium therapy
Patient-centered outcome
Appears in Collections:Journal articles

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