Magnesium status and magnesium therapy in cardiac surgery: A systematic review and meta-analysis focusing on arrhythmia prevention

Jessica L. Fairley, Ling Zhang, Neil J. Glassford, Rinaldo Bellomo

Research output: Contribution to journalReview ArticleResearchpeer-review

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 24 h. Maximal benefit was seen with bolus doses up to 60 mmol. 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.

Original languageEnglish
Pages (from-to)69-77
Number of pages9
JournalJournal of Critical Care
Volume42
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • Arrhythmia
  • Biochemical outcome
  • Critical illness
  • Electrolyte disturbance
  • Intensive care
  • Magnesium
  • Magnesium administration
  • Magnesium therapy
  • Mortality
  • Patient-centered outcome

Cite this

@article{486c88605d624e6cb0f1b3f51c92d4e7,
title = "Magnesium status and magnesium therapy in cardiac surgery: A systematic review and meta-analysis focusing on arrhythmia prevention",
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 24 h. Maximal benefit was seen with bolus doses up to 60 mmol. 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.",
keywords = "Arrhythmia, Biochemical outcome, Critical illness, Electrolyte disturbance, Intensive care, Magnesium, Magnesium administration, Magnesium therapy, Mortality, Patient-centered outcome",
author = "Fairley, {Jessica L.} and Ling Zhang and Glassford, {Neil J.} and Rinaldo Bellomo",
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language = "English",
volume = "42",
pages = "69--77",
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Magnesium status and magnesium therapy in cardiac surgery : A systematic review and meta-analysis focusing on arrhythmia prevention. / Fairley, Jessica L.; Zhang, Ling; Glassford, Neil J.; Bellomo, Rinaldo.

In: Journal of Critical Care, Vol. 42, 01.12.2017, p. 69-77.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Magnesium status and magnesium therapy in cardiac surgery

T2 - A systematic review and meta-analysis focusing on arrhythmia prevention

AU - Fairley, Jessica L.

AU - Zhang, Ling

AU - Glassford, Neil J.

AU - Bellomo, Rinaldo

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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 24 h. Maximal benefit was seen with bolus doses up to 60 mmol. 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.

AB - 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 24 h. Maximal benefit was seen with bolus doses up to 60 mmol. 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.

KW - Arrhythmia

KW - Biochemical outcome

KW - Critical illness

KW - Electrolyte disturbance

KW - Intensive care

KW - Magnesium

KW - Magnesium administration

KW - Magnesium therapy

KW - Mortality

KW - Patient-centered outcome

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U2 - 10.1016/j.jcrc.2017.05.038

DO - 10.1016/j.jcrc.2017.05.038

M3 - Review Article

VL - 42

SP - 69

EP - 77

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -