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• W4387477580 abstract "Introduction Hyperglycaemia is common during cardiac surgery with cardiopulmonary bypass (CPB), both in patients with and without diabetes. Correction of hyperglycaemia with insulin administration reduces hospital complications and decreases mortality in cardiac surgery patients. Experience shows that more insulin is required while on CPB than in other surgeries with similar levels of metabolic stress. We hypothesize that intraoperative hyperglycaemia may be, at least partially, attributable to insulin deficiencies due to adhesion on CPB surfaces and/or degradation by haemolysis. Thus, we investigated in an in-vitro model how insulin levels change in an isolated running extracorporeal circulation (ECC) system. Methods In an in-vitro experiment, extracorporeal bypass pumps were running with red packed blood cells (PBC) and thawed fresh-frozen plasma (FFP) (n=12), the arterial and venous tubing were directly connected. PBC were washed before in a cell salvage system to remove haemolysis products. In six experiments, a mini-ECC (MiECC) with centrifugal pump was used, in six experiments we used a conventional ECC with roller pump. Additionally, we run one conventional ECC with FFP only. Before adding human insulin (Actrapid®), we verified no insulin was present in the blood using a human-insulin specific electrochemiluminescence immunoassay (Elecsys Insulin, Cobas 8000, Roche Diagnostics). The circuit was set to an output of 3.5L/min for 4h. The first hour was run at normothermia (36°C), followed by two hours of mild hypothermia (32°C), followed by a final hour of normothermia. Insulin levels were measured hourly, alongside with the estimation of haemolysis and compared to baseline. A haemolysis index (HI) of 100 (arbitrary units) approximately corresponds to 100 mg/dl haemoglobin. Results In the MiECC, insulin decreased from 315±72 mU/l measured ten minutes after start to 144±73 mU/l after 4h, which corresponds to a -63±11% (p<0.01) drop (figure). In the ECC insulin dropped from 249±45 mU/l ten minutes after start to 21±7 mU/l after 4h, corresponding to a 93±2% (p<0.01) decrease. Of note, the run only with FFP showed no decrease of insulin. HI in the MiECC increased from 53±13 to 76±16 after 4h (change=23±17, p=0.05). In the ECC HI changed from 145±69 to 192±71 after 4h, which corresponds to an increase of 47±7 (p<0.01). HI and percent change of insulin showed an excellent relationship (r= -0.98, p<0.01). Discussion Preliminary in-vitro results show a decrease of insulin concentration over time in both ECC circuits. Our data suggests that the more pronounced loss of insulin in the conventional ECC circuit is likely caused by haemolysis rather than adhesion of insulin to the system. Our findings may have implications on glucose management while on CPB, as higher doses of insulin may be required in an ECC compared to a MiECC to correct hyperglycaemia." @default.
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• W4387477580 date "2023-10-01" @default.
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• W4387477580 title "In-Vitro Investigation of Insulin Dynamics During Four Hours of Simulated Cardiopulmonary Bypass" @default.
• W4387477580 doi "https://doi.org/10.1053/j.jvca.2023.08.026" @default.
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