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

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 microg/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.