Outcomes Study of Hyperinsulinemic Glucose Control in Cardiac Surgery

The Effect of Hyperinsulinemic Glucose Control on Outcomes Following Cardiac Surgery

Patients undergoing cardiac surgery will be randomized into one of two groups. Group A will be administered insulin using the hyperinsulinemic-normoglycemic clamp to normalize blood glucose levels intra-operatively. Group B will be administered insulin at the standard of care levels established by the participating institution. Patients will be followed at 10 days, 15 days and one year post-operatively.

Using a randomized, controlled design, we propose to test the primary hypothesis that normalization of blood glucose using a hyperinsulinemic-normoglycemic clamp technique reduces the risk of a composite outcome (one or more) of 30-day postoperative mortality and serious postoperative cardiac, renal, neurologic, and infectious postoperative complications in patients undergoing cardiac surgery.

Our secondary hypothesis is that hyperinsulinemic normoglycemic therapy will reduce length of stay in intensive care unit, atrial dysrhythmias, creatinine elevation, hospital readmission, all-cause and cardiac one-year mortality.

Inclusion Criteria:

• Age 18-90 years old
• Scheduled for cardiac surgery requiring cardiopulmonary bypass

Exclusion Criteria:

• Off-pump surgical procedures
• Anticipated deep hypothermic circulatory arrest
• In available, baseline cardiac troponin I (>0.5 ng/L) or troponin T (> 0.1 ng/mL) levels (at RVH or CC, respectively)
• Any contraindications to the proposed interventions
• Active infection, including patients with endocarditis or infected pacemaker leads.
• Any infection requiring long- term antibiotics ( > 14 days)
• kidney disease requiring renal replacement therapy