Document Detail


Hypothermic ischemic arrest versus hypothermic potassium cardioplegia in human beings.
MedLine Citation:
PMID:  7049099     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To determine if the addition of potassium enhances the myocardial protective effect of intracoronary perfusion hypothermia during aortic cross-clamping, 50 patients undergoing aortocoronary bypass grafting were studied in a randomized, prospective, double-blind fashion. Twenty-six patients received a cold crystalloid solution infused with a handheld syringe into the root of the cross-clamped aorta every 20 minutes, and 24 patients received the same solution but with 25 mEq/L of potassium chloride added, infused in a similar manner. Both groups were analyzed by mortality, rate of perioperative myocardial infarction (electrocardiographic changes, MB-CPK enzyme release, and preoperative and postoperative gated cardiac blood pool scans), intraoperative hemodynamic changes, intraoperative lactate determinations, postoperative arrhythmias, and requirement for pressor or intraaortic balloon pump support. One patient in the potassium cardioplegia group died (massive pulmonary embolism), and none in the hypothermic perfusion group died. Possible perioperative myocardial infarction was diagnosed by more than one marker in 4 of 26 patients in the hypothermic perfusion group and 5 of 24 patients in the potassium group (p = 0.61). There were no differences between the two groups in terms of hemodynamic changes, lactate production, postoperative arrhythmias, or the need for postoperative hemodynamic support. This study in human beings could not demonstrate a specific protective effect of potassium, beyond that afforded by myocardial perfusion hypothermia and wash-out. The data suggest that myocardial hypothermia, achieved through cold intracoronary arterial perfusion, may be the most important beneficial component of so-called cardioplegia for attaining effective intraoperative myocardial preservation in human beings.
Authors:
M A Jacocks; B N Fowler; J S Chaffin; E Lowenstein; D G Lappas; G M Pohost; C A Boucher; R D Okada; N Hanna; W M Daggett
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  34     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1982 Aug 
Date Detail:
Created Date:  1982-09-10     Completed Date:  1982-09-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  157-65     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Arrhythmias, Cardiac / etiology
Clinical Trials as Topic
Coronary Artery Bypass
Double-Blind Method
Female
Heart Arrest, Induced / methods*
Hemodynamics
Humans
Hypothermia, Induced
Intraoperative Complications
Isotonic Solutions*
Male
Middle Aged
Myocardial Infarction / etiology
Postoperative Complications
Potassium*
Potassium Compounds*
Random Allocation
Grant Support
ID/Acronym/Agency:
GM 15904-12/GM/NIGMS NIH HHS; HL 12322/HL/NHLBI NIH HHS; HL 23591/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Isotonic Solutions; 0/Potassium Compounds; 0/potassium cardioplegic solution; 7440-09-7/Potassium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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