Effect of protocolized MAGNesium replacement in critically ill patients On mortaLIty and Atrial fibrillation: protocol for the MAGNOLIA randomized controlled trial

In adult critically ill patients in Ontario ICUs, a trial will compare protocolized magnesium targets of >0.95 mmol/L versus >0.7 mmol/L to test effects on 30-day outcomes.

• Why it matters: Routine magnesium replacement is common, but the serum targets linked to the best outcomes are unknown, creating uncertainty in ICU care.
• What they did: This open-label, multi-center randomized superiority trial embeds screening and assignment in a shared EHR across 6 hospitals, using opt-out consent and Bayesian intention-to-treat analysis.
• The result: The primary endpoint is a 30-day ordinal composite of death and ICU days free of atrial fibrillation or flutter, with EHR-based outcome capture and multiple secondary safety and utilization measures.

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