Original article: cardiovascularGlucose-Insulin-Potassium in Cardiac Surgery: A Meta-Analysis
Section snippets
Search Strategy
A systematic Medline search was performed using the search terms “cardiac surgery” and “heart surgery” and a set of terms for GIK: glucose, insulin, glucose-insulin, and glucose-insulin-potassium (GIK). We supplemented electronic searches by fact checking the reference lists provided by the studies selected and review articles on GIK therapy.
Inclusion and Exclusion Criteria
We included all randomized GIK studies in cardiac surgery that investigated the recovery of contractile function as a primary endpoint. We considered
Results
A total of 35 trials, conducted between 1970 and 2002, were identified 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40. Twenty-four studies were excluded 8, 9, 10, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40. Three studies were excluded because of lack of randomization 8, 10, 21, 1 because the data were collected retrospectively [32], 1 because aspartate and glutamate
Comment
We demonstrate in this analysis that GIK has the potential to considerably improve recovery of contractile function in patients after cardiac surgery. GIK is further effective in reducing the incidence of postoperative atrial fibrillation.
The first use of GIK in cardiac surgery was described in 1969. Braimbridge and associates [41] reported that GIK was successfully used to treat patients with low cardiac output not responding to isoprenaline, digoxin or pacemaking after triple-valve
Conclusion
We demonstrate in this analysis that GIK may considerably improve recovery of contractile function in patients after cardiac surgery. GIK may further be effective in reducing the incidence of postoperative atrial fibrillation. However, several factors limit the power of this analysis and large, randomized multicenter trials are required to fully assess the efficacy of GIK in cardiac surgery.
Acknowledgements
TD was supported by the Emmy Noether-Program of the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG, Do602/2). We wish to thank Dr Richard D. Weisel for helpful comments and suggestions.
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