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Title: Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study.
Austin Authors: Osawa, Eduardo A;Cutuli, Salvatore L ;Cioccari, Luca;Bitker, Laurent;Peck, Leah ;Young, Helen ;Hessels, Lara;Yanase, Fumitaka ;Fukushima, Julia T;Hajjar, Ludhmila A;Seevanayagam, Siven ;Matalanis, George ;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Department of Critical Care, University of Groningen, University Medical Center, Groningen, The Netherlands
Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli, Universita Cattolica del Sacro Cuore, Rome, Italy
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
Centre for Integrated Critical Care, School of Medicine, The University of Melbourne, Melbourne, Australia
Intensive Care
Cardiac Surgery
Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland
Department of Cardiology, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Issue Date: Nov-2020
Date: 2020-05-21
Publication information: Journal of Cardiothoracic and Vascular Anesthesia 2020; 34(11): 2940-2947
Abstract: 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. Sequential, matched, case-controlled pilot study. Tertiary university hospital. Matched cohort of 99 patients before and intervention cohort of 99 consecutive patients after the introduction of a continuous magnesium infusion protocol. 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. 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). 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.
DOI: 10.1053/j.jvca.2020.04.006
ORCID: 0000-0003-3859-3537
Journal: Journal of Cardiothoracic and Vascular Anesthesia
PubMed URL: 32493662
Type: Journal Article
Subjects: cardiac surgery
intensive care
sequential matching
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