Forty years of glucose–insulin–potassium (GIK) in cardiac surgery: a review of randomized, controlled trials

Abstract

Glucose-insulin-potassium (GIK) solutions have been used in cardiac surgery for more than 40 years. At that time, membrane-polarizing and stabilizing effects on cardiomyocyte's action potential were regarded the main benefit. Two meta-analyses described methodological flaws in the early studies (e.g., case numbers, randomization principles, and levels of significance), and came to clearly different recommendations with regard to the usage of GIK in the therapy of acute myocardial function. During the 70s, as promising therapies for the treatment of AMI had become available (e.g., beta-blockers and thrombolytic agents), the GIK technique was more widely introduced in cardiac surgery, e.g., during valve replacement. At present, 74 of 91 studies provide convincing evidence for the beneficial effects of insulin and/or GIK in cardiac surgery that go far beyond simple metabolic benefits and also include better recovery of myocardial tissue after ischemia. Yet, the exact underlying mechanisms remain still unknown. In this review article, two questions will be answered: why did GIK not become daily routine in cardiac surgery in spite of positive results from clinical studies, and does this technique merit more acceptance among the potential users? In view of the increasing number of older patients at higher risk, the demand for improving surgical procedures has renewed the interest in the GIK concept. The more recent literature suggests that the entire potential of GIK solutions has not been fully disclosed. A large single or multicenter trial with sound endpoints is mandatory.

Effect of glucose–insulin–potassium on hyperlactataemia in patients undergoing valvular heart surgery

“…31 The consequences of this potential drawback are still a matter of debate, but none of the meta-analyses of GIK studies has revealed any negative results to date. 32,33 In the current trial, enrolled patients had two or more risk factors for hyperlactataemia and the overall incidence of hyperlactataemia was 60% as we expected, which was higher than the results of previous studies (approximately 20%). [2][3][4][5] Patients developing hyperlactataemia showed higher incidences of renal failure and reoperation and longer durations of ventilator care, ICU and hospital stay regardless of the group in the current trial (data not 560 Roh et al shown).…”

Glucose-Insulin-Potassium for Acute Myocardial Infarction

“…However, the reader should be aware that a vast body of literature also exists on the use of GIK, insulin-glucose, or insulin alone in critically ill patients (due to various causes) in the intensive care unit, as well as in the cardiac surgery patient. [53][54][55][56][57][58][59][60] Although it is beyond the scope of the present article to review these studies in depth, several highlights of this field are worthy of attention and are presented in the online-only Data Supplement.…”

High-dose insulin therapy for neurogenic-stunned myocardium after stroke

“…These drugs may have serious adverse effects including tachycardia, hypotension and increased myocardial oxygen demand. The metabolic resuscitation with insulin has been investigated for many years in cardiogenic shock 14. In both ischaemic and non-ischaemic shock, there is a diversion of myocardial metabolism from fatty acids to preferential carbohydrate oxidation and insulin could stimulate glucose myocardial uptake.…”