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Glucose-Insulin-Potassium Reduces The Incidence Of Low Cardiac Output Episodes


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#1 SerendepitySaki

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Posted 21 January 2011 - 10:22 PM

sort of "old" news, if you've been following it....
but still, some interesting potential implications in prehospital/transport settings...
uber easy peasy research projects just waiting to happen....
anyone got a medical director who is academic faculty and must "publish or perish"? ;-)


http://www.ncbi.nlm....pubmed/21200004
Circulation. 2011 Jan 18;123(2):170-7. Epub 2011 Jan 3.


Glucose-Insulin-Potassium Reduces the Incidence of Low Cardiac Output Episodes After Aortic Valve Replacement for Aortic Stenosis in Patients With Left Ventricular Hypertrophy: Results From the Hypertrophy, Insulin, Glucose, and Electrolytes (HINGE) Trial.
Howell NJ, Ashrafian H, Drury NE, Ranasinghe AM, Contractor H, Isackson H, Calvert M, Williams LK, Freemantle N, Quinn DW, Green D, Frenneaux M, Bonser RS, Mascaro JG, Graham TR, Rooney SJ, Wilson IC, Pagano D.

Department of Cardiothoracic Surgery, University Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK. domenico.pagano@uhb.nhs.uk.


Abstract
Background- Patients undergoing aortic valve replacement for critical aortic stenosis often have significant left ventricular hypertrophy. Left ventricular hypertrophy has been identified as an independent predictor of poor outcome after aortic valve replacement as a result of a combination of maladaptive myocardial changes and inadequate myocardial protection at the time of surgery. Glucose-insulin-potassium (GIK) is a potentially useful adjunct to myocardial protection. This study was designed to evaluate the effects of GIK infusion in patients undergoing aortic valve replacement surgery. Methods and Results- Patients undergoing aortic valve replacement for aortic stenosis with evidence of left ventricular hypertrophy were randomly assigned to GIK or placebo. The trial was double-blind and conducted at a single center. The primary outcome was the incidence of low cardiac output syndrome. Left ventricular biopsies were analyzed to assess changes in 5' adenosine monophosphate-activated protein kinase (AMPK), Akt phosphorylation, and protein O-linked β-N-acetylglucosamination (O-GlcNAcylation). Over a 4-year period, 217 patients were randomized (107 control, 110 GIK). GIK treatment was associated with a significant reduction in the incidence of low cardiac output state (odds ratio, 0.22; 95% confidence interval, 0.10 to 0.47; P=0.0001) and a significant reduction in inotrope use 6 to 12 hours postoperatively (odds ratio, 0.30; 95% confidence interval, 0.15 to 0.60; P=0.0007). These changes were associated with a substantial increase in AMPK and Akt phosphorylation and a significant increase in the O-GlcNAcylation of selected protein bands. Conclusions- Perioperative treatment with GIK was associated with a significant reduction in the incidence of low cardiac output state and the need for inotropic support. This benefit was associated with increased signaling protein phosphorylation and O-GlcNAcylation. Multicenter studies and late follow-up will determine whether routine use of GIK improves patient prognosis. Clinical Trial Registration- URL: http://www.controlled-trials.com. Reference number: ISRCTN 05758301.


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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#2 JLP

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Posted 22 January 2011 - 12:04 AM

Sean:

thanks for posting this. I have been reading for several years about the positive effects of insulin on cardiac function in stressed hearts, so it's nice to see that someone has started to build some evidence to support it's use. Wish I knew someone who's ear I could plant a bug in.
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#3 old school

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Posted 22 January 2011 - 02:11 PM

Interesting....did I hear about places using GIP for AMI's with low cardiac output, or am I making things up again?
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bring it in for the real thing

#4 SerendepitySaki

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Posted 22 January 2011 - 04:35 PM

in one form or another, you gentlemen are singing my song.... that was exactly my point, OldSchool...

an enterprising staff member who had previously expressed an interest in research could very easily review the current literature and whip up a number of easy peasy new low-cost projects that would make it past an IRB.... have fun running with the ball and holler at me if you want a second set of eyes behind the scenes....

not sure my medical directors would be interested, but I may shop it to a few others.... who knows maybe we'll find that there's opportunity for a multi-center collaboration?
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#5 pureadrenalin

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Posted 11 April 2011 - 02:05 AM

We had a GIK trial done here in Milwaukee county. Pretty successful for the most part. It was premixed in a bag by the Medical College of Wisconsin in Milw. County, and was given as protocol in PNB's, alongside a placebo. Only the pharmacy at MCW knew what was what. Total blind study.

I totally support it. Hopefully enough science gets done on it, and it proves as good as the theory suggests.
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#6 SerendepitySaki

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Posted 11 April 2011 - 07:08 AM

+1 good stuff, man.... always glad to see something make out of the units and onto the streets...
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#7 SerendepitySaki

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Posted 30 March 2012 - 10:19 PM

http://www.ems1.com/...may-save-lives/
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup