Document Detail

Prophylactic magnesium for improving neurologic outcome after aneurysmal subarachnoid hemorrhage: systematic review and meta-analysis.
MedLine Citation:
PMID:  23192249     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Neurologic disability is common after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to systematically review the prophylactic use of magnesium to improve neurologic outcomes in these patients.
METHODS: We searched MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials to June 2012 for randomized and quasi-randomized controlled trials of intravenous magnesium in adults after aSAH, given before radiologic vasospasm or delayed cerebral ischemia (DCI) and compared with any control group. Two reviewers independently extracted data on study population, interventions, and outcomes (good neurologic outcome [primary outcome], cerebral infarction, DCI, radiographic vasospasm, mortality, adverse events). Analyses used random-effects models.
RESULTS: Of 702 citations, 13 trials (n = 2401) met the selection criteria. Meta-analyses showed that magnesium did not increase the probability of good neurologic outcome (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.97-1.07; P = .49; 12 trials, n = 2345) or decrease the risks of cerebral infarction (RR, 0.69; 95% CI, 0.46-1.05; P = .08; 5 trials, n = 572), radiographic vasospasm (RR, 0.86; 95% CI, 0.71-1.04; P = .13; 7 trials, n = 438), or mortality (RR, 0.98; 95% CI, 0.80-1.20; P = .86; 11 trials, n = 2092). Magnesium did reduce the risk of DCI (RR, 0.73; 95% CI, 0.56-0.96; P = .02; 10 trials, n = 1095). Data on adverse events were generally sparse.
CONCLUSIONS: Despite decreasing the incidence of DCI in patients with aSAH, prophylactic intravenous magnesium does not improve neurologic outcome or decrease cerebral infarction, radiographic vasospasm, or mortality.
Eyal Golan; Daniela N Vasquez; Niall D Ferguson; Neill K J Adhikari; Damon C Scales
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2012-11-26
Journal Detail:
Title:  Journal of critical care     Volume:  28     ISSN:  1557-8615     ISO Abbreviation:  J Crit Care     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-07     Completed Date:  2013-09-20     Revised Date:  2013-12-20    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  173-81     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Brain Ischemia / prevention & control
Clinical Trials as Topic
Magnesium / administration & dosage,  therapeutic use*
Nervous System Diseases / physiopathology,  prevention & control
Subarachnoid Hemorrhage / drug therapy*,  physiopathology
Treatment Outcome
Vasospasm, Intracranial / prevention & control
Reg. No./Substance:
Comment In:
J Crit Care. 2013 Dec;28(6):1102   [PMID:  24035009 ]
J Crit Care. 2013 Dec;28(6):1101   [PMID:  23867720 ]

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