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Milrinone use in Neurocritical Care Setting

The purpose of the study will be to assess the following the current utilization of milrinone across participant practice locations and practice habits around the use of milrinone for the treatment of delayed cerebral ischemia and/or cerebral vasospasm following securement of subarachnoid hemorrhage.

Please complete the survey below.

Thank you!

What is institution(s) do you have privileges at and participate in the care of patients with complications following subarachnoid hemorrhage?

* must provide value

What consentient(s) or region(s) is the institution(s) located in?

* must provide value

Africa

Asia

Australia and Oceania

Central America

Europe

Middle East

North America

South America

What is your role in caring for patients?

* must provide value

Anesthesiologist/Anesthetist

Intensivist

Neuro-intensivitist (MD/DO/MBBS)

Neurosurgeon (MD/DO/MBBS)

Neurology Advanced Practice Provider (PA/NP)

Pharmacist

Other

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How often do you use milrinone in patients with symptomatic vasospasm or delayed cerebral ischemia?

* must provide value

Always

Often

Sometimes

Rarely

Never

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What is the trigger or complication prompting initiation of therapy? (Select all that apply)

* must provide value

Neurologic decline not otherwise fully attributable to seizure, hydrocephalus, or other systemic processes Angiographic vasospasm Other

Is milrinone considered your institutions first-line, non-angiographic intervention?

* must provide value

Yes No

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What is your first-line non-angiographic intervention if not utilizing milrinone? (Select all that apply)

* must provide value

Hypertension therapy Hypervolemia therapy Other

Do you initiate or continue any of the following with milrinone therapy? (Select all that apply)

* must provide value

Hypertension therapy Hypervolemia therapy Non-dihydropyridine calcium blockers Other No other interventions

Does your institution have a standardized protocol for milrinone use for aneurysmal subarachnoid hemorrhage?

* must provide value

Yes No

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What is the typical initial milrinone infusion rate?

What is the typical maximum milrinone infusion rate?

When initiating milrinone, do you utilize an initial bolus with the infusion?

* must provide value

Yes No

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Usually, do you re-bolus with each/most dose titration?

* must provide value

Yes

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When do you begin to wean or discontinue milrinone?

* must provide value

At symptom resolution

After 24 hours of symptom resolution

After 48 hours of symptom resolution

Other

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If symptoms reoccur during weaning or after cessation of milrinone what intervention(s) is/are made? (Select all that apply)

* must provide value

Restart milrinone

Angiography intervention

Other

If hypotension (systolic blood pressure less than 90 mmHg) occurs during milrinone therapy what actions do you take? (Select all that apply)

Fluid bolus

Initiation of a vasopressor

Weaning or discontinuing milrinone

Other

If cerebral brain edema develops during therapy, what are your management options? (Select all that apply)

* must provide value

Reduced milrinone dose

Discontinue milrinone

Mannitol therapy

Hypertonic saline

Other

What pharmacotherapy does your institution routinely utilize for delayed cerebral ischemia or cerebral vasospasms following securement of non-traumatic subarachnoid hemorrhages? (Select all that apply)

* must provide value

Non-dihydropyridine calcium blockers

Hypervolemia/euvolemia and hypertension protocol

Other

What are your reservations to implementing a milrinone protocol at your institution for this indication? (Select all that apply)

* must provide value

Unfamiliar with the use/data of milrinone for this indication

Limitations of existing published data

Concerns potential adverse events related to milrinone use outweigh benefits

Lack of guideline recommendation or expert consensus on the best practices to implement the use of milrinone

Other

What percentage of providers utilized milrinone regularly or on occasion at your institution(s) for this indication?

* must provide value

0% to 25% 26% to 50% 51% to 75% 76 to 100% Unsure

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Would you being willing to participate in a randomized control trial comparing milrinone to your current standard of care?

* must provide value

Yes

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