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

Nicolas-Robin, Armelle MD; Amour, Julien MD, PhD; Ibanez-Esteve, Cristina MD; Coriat, Pierre MD; Riou, Bruno MD, PhD; Langeron, Olivier MD, PhD

doi: 10.1097/CCM.0b013e318186f64b
Continuing Medical Education Article
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CME

Background: As a result of donor heart shortage, resorting to marginal heart donors is being promoted. Dobutamine is usually used to support these potential donors and has been proposed to identify the reversible part of the brain death-induced myocardial dysfunction before potential organ donation. But dobutamine impairs the oxygen supply-demand balance and may increase myocardial ischemia. The aim of this study was to compare the effects of dobutamine and glucose-insulin-potassium on the left ventricular systolic dysfunction in brain dead patients.

Methods and Results One hundred thirty-five consecutive brain dead patients were prospectively screened. Twelve of them with severe acute heart failure defined by an echocardiographic ejection fraction area <30% received 10 μg/kg/min dobutamine infusion over 30 min and, after return to baseline cardiac function, glucose-insulin-potassium infusion over 120 min. With dobutamine, ejection fraction area significantly increased (39 ± 14 vs. 21 ± 6%, p < 0.0001) whereas mean diastolic arterial pressure decreased (71 ± 9 vs. 89 ± 18 mm Hg, p < 0.05) and heart rate increased (150 ± 16 vs. 118 ± 24 beats/min, p < 0.01). After glucose-insulin-potassium infusion, ejection fraction area significantly increased (37 ± 8 vs. 21 ± 6%, p < 0.0001), without significant changes in mean arterial blood pressure (79 ± 16 vs. 89 ± 18 mm Hg, nonsignificant) and heart rate (116 ± 18 vs. 118 ± 24 beats/min, nonsignificant).

Conclusion: Glucose-insulin-potassium was as efficient as dobutamine in improving ventricular systolic function in brain-dead patients, without the side effects of dobutamine.

LEARNING OBJECTIVES On completion of this article, the reader should be able to:

  1. Identify issues related to heart transplant.
  2. Explain protocol used to evaluate and support cardiac function in potential donors.
  3. Use this information in a clinical setting.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

All faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationship with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity.

Visit the Critical Care Medicine Web Site (www.ccmjournal.org) for information on obtaining continuing medical education credit.

Staff Anesthesiologist (AN-R, CI-E), Associate Professor (JA), Professor of Anesthesiology and Chairman (PC), Professor of Anesthesiology (OL), Departments of Anesthesiology and Critical Care; and Professor of Anesthesiology and Chairman (BR), Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitie-Salpetriere, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: armelle.nicolas-robin@psl.aphp.fr

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins