Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: A randomized controlled trial

We sought to assess the role of glucose-insulin-potassium in providing myocardial protection in nondiabetic patients undergoing coronary artery surgery with cardiopulmonary bypass. A prospective, randomized, double-blind, placebo-controlled trial was conducted at a single-center university hospital...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2006, Vol.131 (1), p.34-42.e2
Main Authors: Quinn, David W., Pagano, Domenico, Bonser, Robert S., Rooney, Stephen J., Graham, Timothy R., Wilson, Ian C., Keogh, Bruce E., Townend, John N., Lewis, Michael E., Nightingale, Peter
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiomyopathies - etiology
Cardiomyopathies - prevention & control
Cardioplegic Solutions - therapeutic use
Cardiopulmonary Bypass
Coronary Artery Bypass - adverse effects
Double-Blind Method
Female
Glucose - therapeutic use
Humans
Insulin - therapeutic use
Male
Medical sciences
Middle Aged
Potassium - therapeutic use
Prospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
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Summary:We sought to assess the role of glucose-insulin-potassium in providing myocardial protection in nondiabetic patients undergoing coronary artery surgery with cardiopulmonary bypass. A prospective, randomized, double-blind, placebo-controlled trial was conducted at a single-center university hospital performing adult cardiac surgery. Two hundred eighty nondiabetic adult patients undergoing first-time elective or urgent isolated multivessel coronary artery bypass grafting were prospectively randomized to receive glucose-insulin-potassium infusion or placebo (dextrose 5%) before, during, and for 6 hours after surgical intervention. Anesthetic, cardiopulmonary bypass, myocardial protection, and surgical techniques were standardized. The primary end point was postreperfusion cardiac index. Secondary end points were systemic vascular resistance index, the incidence of low cardiac output episodes, inotrope and vasoconstrictor use, and biochemical-electrocardiographic evidence of myocardial injury. The incidence of dysrhythmias and infections requiring treatment was recorded prospectively. The glucose-insulin-potassium group experienced higher cardiac indices ( P < .001) throughout infusion and reduced vascular resistance ( P < .001). The incidence of low cardiac output episodes was 15.9% (22/138) in the glucose-insulin-potassium group and 27.5% (39/142) in the placebo group ( P = .021). Inotropes were required in 18.8% (26/138) of the glucose-insulin-potassium group and 40.8% (58/142) of the placebo group ( P < .001). Fewer patients in the glucose-insulin-potassium group (12.3% [16/133]) versus those in the placebo group (23.4% [32/137]) had significant myocardial injury ( P = .017). Noncardiac morbidity was not different. Glucose-insulin-potassium therapy improves early postoperative cardiovascular performance, reduces inotrope requirement, and might reduce myocardial injury. These potential benefits are not at the expense of increased noncardiac morbidity.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2005.05.057