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Effect of glucose-insulin-potassium in severe acute heart failure after brain death

Armelle Nicolas-Robin1, Julien Amour, Cristina Ibanez-Esteve

  • 1Department of Anesthesiology, Centre Hospitalo-Universitaire Pitie-Salpetriere, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. armelle.nicolas-robin@psl.aphp.fr

Critical Care Medicine
|September 4, 2008
PubMed

Insights

Glucose-insulin-potassium effectively improves heart function in brain-dead patients, similar to dobutamine but without adverse effects. This finding supports its use in managing myocardial dysfunction in potential organ donors.

Area of Science:

  • Cardiology
  • Organ Donation
  • Critical Care Medicine

Background:

  • Donor heart shortages necessitate using marginal donors.
  • Brain death can cause myocardial dysfunction, potentially reversible.
  • Dobutamine, used to support donors, may worsen ischemia.

Purpose of the Study:

  • Compare dobutamine and glucose-insulin-potassium (GIK) for left ventricular systolic dysfunction in brain-dead patients.
  • Evaluate GIK as a safer alternative to dobutamine.

Main Methods:

  • Prospective screening of 135 brain-dead patients.
  • Twelve patients with ejection fraction <30% received dobutamine (10 mcg/kg/min for 30 min).
  • Following recovery, patients received GIK infusion (over 120 min).

Main Results:

  • Dobutamine increased ejection fraction (21% to 39%) but decreased blood pressure and increased heart rate.
  • GIK also increased ejection fraction (21% to 37%) without significant changes in blood pressure or heart rate.
  • Both interventions improved systolic function, but GIK had a more favorable hemodynamic profile.

Conclusions:

  • GIK is as effective as dobutamine in improving ventricular systolic function in brain-dead patients.
  • GIK offers a safer alternative by avoiding dobutamine's side effects.
  • This supports GIK for managing myocardial dysfunction in potential organ donors.
Abstract

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