title: Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: a randomized controlled trial.
abstract: OBJECTIVE
  We sought to assess the role of glucose-insulin-potassium in providing myocardial protection in nondiabetic patients undergoing coronary artery surgery with cardiopulmonary bypass.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, United Kingdom.
authors.forename: David W
authors.initials: DW
authors.lastname: Quinn
authors.forename: Domenico
authors.initials: D
authors.lastname: Pagano
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bonser
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rooney
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Graham
authors.forename: Ian C
authors.initials: IC
authors.lastname: Wilson
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Keogh
authors.forename: John N
authors.initials: JN
authors.lastname: Townend
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lewis
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
mesh_terms: D009202:Cardiomyopathies / Q000209:etiology / Q000517:prevention & control*; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium