Limiting ischemic myocardial damage using glucose-insulin-potassium solutions

• Published in: The Annals of thoracic surgery Vol. 60; no. 2; pp. 411 - 416
• Main Authors: Lazar, Harold L., Zhang, X., Rivers, Samuel, Bernard, Sheilah, Shemin, Richard J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.1995; Elsevier Science
• Subjects: Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Blood Glucose - analysis; Cardioplegic Solutions - therapeutic use; Cardiopulmonary Bypass; Glucose - therapeutic use; Hydrogen-Ion Concentration; Insulin - therapeutic use; Medical sciences; Myocardial Reperfusion Injury - pathology; Myocardial Reperfusion Injury - prevention & control; Myocardium - chemistry; Necrosis; Potassium - blood; Potassium - therapeutic use; Swine; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Cardioplegic solution; Animal model; General anesthesia; Glucose; Insulin; Induced cardiocirculatory arrest; Pig; Result; Vertebrata; Mammalia; Ischemia; Animal; Myocardium; Artiodactyla; Technique; Potassium; Ungulata; Solution
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(95)00402-7

This experimental study sought to determine whether the infusion of glucose-insulin-potassium (GIK) solutions to ischemic myocardium during revascularization would decrease myocardial damage. In 40 pigs, the second and third diagonal vessels were occluded with snares for 90 minutes followed by 30 minutes of cardioplegic arrest and 180 minutes of reperfusion. During the periods of coronary occlusion and reperfusion, 10 pigs received GIK (glucose = 300 g/L, insulin = 50 U/L, K + = 80 mEq/L) through the jugular vein at 1 mL · kg −1 · h −1 (GIK-IV group); 10 pigs received GIK through the coronary sinus (GIK-CS group); 5 pigs received GIK through the jugular vein during reperfusion only (GIK-R group); 5 pigs received GIK through the jugular vein 2 hours prior to coronary occlusion and then during the periods of coronary occlusion and reperfusion (GIK-Pre group); and 10 pigs received no GIK (Unmodified group). Ischemic damage was assessed by wall motion scores using two-dimensional echocardiography, changes in myocardial tissue pH, and the area of necrosis in the area of risk. Hearts treated with GIK had significantly less tissue acidosis, higher wall motion scores, and the least tissue necrosis (14% ± 2% GIK-Pre versus 12% ± 2% GIK-CS versus 16% ± 2% GIK-IV versus 25% ± 2% GIK-R versus 73% ± 4% Unmodified; all, p < 0.05 versus Unmodified). We conclude that a glucose-insulin-potassium solution reduces ischemic myocardial damage during coronary revascularization.