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The Annals of Thoracic Surgery, Vol 48, 484-489, Copyright © 1989 by The Society of Thoracic Surgeons
S Gradinac, GM Coleman, H Taegtmeyer, MS Sweeney and OH Frazier
To assess the effectiveness of metabolic support for the heart in patients
with refractory heart failure after hypothermic ischemic arrest for
aortocoronary bypass grafting we assigned 22 patients to receive either
intravenous glucose (50%), insulin (80 IU/L), and potassium (100 mEq/L) at
a rate of 1 mL/kg/h for up to 48 hours (GIK) or glucose (5%) and NaCl
(0.225%) at the same rate (control). All patients started out with a mean
cardiac index of less than 3.0 L/min/m2, were on intraaortic balloon pump
assistance, and required inotropic drugs. At 12 and 24 hours cardiac index
had increased significantly in the GIK group when compared with the control
group (3.6 and 3.4 versus 2.5 and 2.7 L/min/m2, respectively). Time on the
intraaortic balloon pump (39 versus 61 hours) and requirements for
inotropic drug support were significantly less in GIK group than in the
control group. All 11 GIK patients could be weaned from intraaortic balloon
pump assistance. At 30 days after operation survival was 10/11 in the GIK
group, compared with 7/11 in the control group. We conclude that GIK is
both safe and effective in the treatment of refractory left ventricular
failure after aortocoronary bypass grafting. The exact mechanism for the
beneficial effect of GIK on myocardial contractility remains to be
elucidated.
ARTICLES
Improved cardiac function with glucose-insulin-potassium after aortocoronary bypass grafting
Division of Cardiology, University of Texas Medical School, Houston.
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