Effects of hypothermia on myocardial substrate selection

Gilbert, Nathan F.; Meyer, Paul E; Tauriainen, Milla-Maria; Chao, Robert; Patel, J. D.; Malloy, Craig R.; Jessen, Michael E.

doi:10.1016/s0003-4975(02)03873-0

Cited by 15 publications

(10 citation statements)

References 22 publications

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“…6 Hypothermia changes myocardial substrate selection, resulting in reduced metabolic oxygen consumption via less fatty acid catabolism. 25 Hypothermia may reduce ATP depletion during ischemia and produce mRNA elevation for heat shock protein 70-1, mitochondrial proteins, adenine nucleotide translocator (ANT 1 ), and ␤-F 1 -ATPase, resulting in less mitochondrial dysfunction and increased functional recovery of the heart. 26 Many of the toxic effects in ischemia/reperfusion injury are related to the NO-superoxide-peroxynitrite pathway and subsequent detrimental enzymatic oxidative cascades that are released, leading to cell death and tissue damage.…”

Section: Discussionmentioning

confidence: 99%

Hypothermia Improves Defibrillation Success and Resuscitation Outcomes From Ventricular Fibrillation

et al. 2005

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Background-Induced hypothermia is recommended to improve neurological outcomes in unconscious survivors of out-of-hospital ventricular fibrillation (VF) cardiac arrest. Patients resuscitated from a VF arrest are at risk of refibrillation, but there are few data on the effects of already existing hypothermia on defibrillation and resuscitation. Methods and Results-Thirty-two swine (meanϮSE weight, 23.0Ϯ0.6 kg) were divided into 4 groups: normothermia (nϭ8), mild hypothermia (35°C) (nϭ8), moderate hypothermia (33°C) (nϭ8), and severe hypothermia (30°C) (nϭ8). Hypothermia was induced by surrounding the animal with ice, and VF was electrically induced. After 8 minutes of unsupported VF (no CPR), the swine were defibrillated (biphasic waveform) with successive shocks as needed and underwent CPR until resumption of spontaneous circulation or no response (Ն10 minutes). First-shock defibrillation success was higher in the moderate hypothermia group (6 of 8 hypothermia versus 1 of 8 normothermia; Pϭ0.04). The number of shocks needed for late defibrillation (Ն1 minute after initial shock) was less in all 3 hypothermia groups compared with normothermia (all PϽ0.05). None of the 8 animals in the normothermia group achieved resumption of spontaneous circulation compared with 3 of 8 mild hypothermia (PϭNS), 7 of 8 moderate hypothermia (Pϭ0.001), and 5 of 8 severe hypothermia (Pϭ0.03) animals. Coronary perfusion pressure during CPR was not different between the groups. Conclusions-When VF was induced in the setting of moderate or severe hypothermia, resuscitative measures were facilitated with significantly improved defibrillation success and resuscitation outcome. The beneficial effect of hypothermia was not due to alteration of coronary perfusion pressure, which suggests that changes in the mechanical, metabolic, or electrophysiological properties of the myocardium may be responsible.

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Section: Discussionmentioning

confidence: 99%

Hypothermia Improves Defibrillation Success and Resuscitation Outcomes From Ventricular Fibrillation

et al. 2005

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“…The heart can oxidize a wide range of substrates and glucose alone can support isolated working hearts. However, in these experiments, machine perfusion was performed under profound hypothermia and depolarized arrest, conditions that have been shown to alter myocardial substrate selection [22,23]. As well, uptake of glucose may be inefficient at low temperature, particularly when insulin is not available [24].…”

Section: Discussionmentioning

confidence: 99%

Glucose is an Ineffective Substrate for Preservation of Machine Perfused Donor Hearts

Cobert

Peltz

West

et al. 2012

Journal of Surgical Research

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“…Accumulation of FFAs is toxic to the heart 40–49 and is associated with increased membrane damage, arrhythmias, and accelerated deterioration of myocardial function 40 , 50 . Surgical stress, pharmacological agents, and induced hypothermia during CPB all increase FFA accumulation 38,40,47,50 . Free fatty acids reduce myocardial glucose extraction 51 just when myocardial glucose requirements are increased 39 .…”

Section: Behavioral Objectivesmentioning

confidence: 99%

“…One rationale for the use of GIK is that providing glucose and insulin eases the transition from anaerobic metabolism to aerobic metabolism without increasing myocardial workload 36,46,66,67 . Shifting to aerobic metabolism removes FFA from the blood and increases use of excess glucose, thus improving adenosine triphosphate production 43 , 47 . Infusing potassium raises decreased serum potassium levels that further inhibit insulin release 56 …”

Section: Behavioral Objectivesmentioning

confidence: 99%

Perioperative blood glucose control during adult coronary artery bypass surgery

Lorenz¹,

Lorenz²,

Codd³

2005

AORN Journal

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Coronary artery bypass graft (CABG) procedures are among the most frequently performed surgical procedures in the United States. People with cardiovascular disease who also have diabetes have a greater risk of poor outcomes after CABG procedures than patients who do not have diabetes. This literature review examines current information regarding perioperative blood glucose (BG) control. It emphasizes BG control in adults during the hypothermic period of cardiopulmonary bypass. Hyperglycemia, not the diagnosis of diabetes, significantly increases the risk of adverse clinical outcomes, longer hospitalizations, and increased health care costs.

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Effects of hypothermia on myocardial substrate selection

Cited by 15 publications

References 22 publications

Hypothermia Improves Defibrillation Success and Resuscitation Outcomes From Ventricular Fibrillation

Hypothermia Improves Defibrillation Success and Resuscitation Outcomes From Ventricular Fibrillation

Glucose is an Ineffective Substrate for Preservation of Machine Perfused Donor Hearts

Perioperative blood glucose control during adult coronary artery bypass surgery

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