MYOCARDIAL PROTECTION DURING ISCHEMIC CARDIAC-ARREST - POSSIBLE DELETERIOUS EFFECTS OF GLUCOSE AND MANNITOL IN CORONARY INFUSATES

  • 1 January 1978
    • journal article
    • research article
    • Vol. 76  (1) , 16-23
Abstract
Cardioplegic protective infusates are designed to induce rapid diastolic arrest and also to reduce or delay the onset of ischemic damage. The use of such infusates can greatly improve postischemic recovery of cardiac function. A number of investigators include glucose, insulin, or mannitol in their infusates in an attempt to increase the amount of protection afforded to the ischemic myocardium. Under certain conditions these additives can be detrimental to tissue protection as shown using an isolated, working rat heart model of cardiopulmonary bypass and ischemic cardiac arrest. The deleterious effects of glucose and mannitol are dose dependent and can be modificed by the inclusion of insulin in the infusate. The damaging effects of glucose appear to be both osmotic and metabolic in origin and those of mannitol, purely osmotic. The effects of insulin are complex and may affect a number of cellular processes.