A randomized controlled study comparing high-dose insulin to vasopressors or combination therapy in a porcine model of refractory propranolol-induced cardiogenic shock

Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
Katherine G KatzungKristin M Engebretsen

Abstract

Context: Although cerebral perfusion (CP) is preserved across a wide range of mean arterial pressures (MAP) through cerebral-vascular autoregulation, the relationship between MAP and CP in refractory poison-induced cardiogenic shock (PICS) has never been studied. We compared the effects of therapies used in PICS: high-dose insulin (HDI), HDI plus norepinephrine (NE), and vasopressors alone (NE plus epinephrine (Epi)) on cerebral tissue oxygenation (PtO2). Methods: Fifteen swine were randomized to either HDI, HDI + NE, or NE + Epi. All animals received a propranolol infusion using an established model of toxicity. At primary toxicity (P1), defined as a 25% reduction in heart rate (HR) multiplied by MAP, the HDI and HDI + NE groups received HDI and the NE + Epi group received NE. Once a sustained MAP < 55 mmHg was reached (P2), the HDI group received saline (NS), the HDI + NE group received NE and the NE + Epi group received Epi until death or censoring. PtO2 and hemodynamic parameters including MAP, cardiac output (CO) and central venous pressure (CVP) were measured every 10 minutes. Glucose and potassium were measured at predetermined intervals. Results: Animals treated with HDI + NE maintained PtO2 over time more than the HDI-...Continue Reading

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Citations

Mar 3, 2020·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Erik LindemanJohanna Nordmark Grass
Apr 21, 2020·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Joe-Anthony RotellaAnselm Wong
Jul 14, 2020·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Justin N CorcoranJon B Cole
Jan 26, 2020·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Jon B ColeSamuel J Stellpflug
Aug 7, 2019·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Sean P BoleySamuel J Stellpflug
Jun 5, 2020·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Jenna M LeRoySamuel J Stellpflug

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