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Introduction Aneurysmal subarachnoid hemorrhage (aSAH) is a cause of severe brain injury. In patients who survive the initial rupture, vasospasm and delayed cerebral ischemia (DCI) have been established as markers of morbidity and mortality.Aim of study To evaluate the potential benefit of intravenous (IV) milrinone as a preventive strategy for delayed cerebral ischemia (DCI) following aSAH, and to assess its impact on functional outcomes and mortality.Method We conducted a retrospective cohort study in Colombia on patients with aSAH treated with aneurysm embolization. Patients were divided 2:1 into standard care and standard care plus IV milrinone groups. Outcomes assessed included functional status (mRS ≤3) at discharge and 90 days, mortality, vasospasm, and DCI. Subgroup analysis evaluated milrinone tolerance, need for rescue angioplasty, and infectious complications.Abstract A232 Figure 1Results Among 94 patients, 33 received IV milrinone in addition to standard care; 27.2% did not tolerate it due to hypotension or arrhythmia. Functional outcomes (mRS≤3) were similar between milrinone and control groups at discharge (54.2% vs 59.1%) and 90 days (62.5% vs 60.5%). However, patients with good milrinone tolerance had significantly better outcomes than those without tolerance (54.2% vs 11.1%, p=0.001). DCI was more frequent in the no-milrinone and no-tolerance groups. Mortality was lower in the milrinone group (12.5% vs 26.7%), with significantly higher mortality in patients who did not tolerate milrinone (77.7% vs 12.5%, p=0.001), suggesting tolerance influences prognosis.Abstract A232 Figure 2Conclusion In our study we found that prophylactic treatment with IV milrinone in patients with aSAH was associated with lower occurrence of DCI and lower mortality rates.Conflict of Interest No