Cardiac cocktail delivered by medics may save lives
The mixture of glucose, insulin and potassium, or GIK, show remarkable success in preventing full cardiac arrest
AFP
CHICAGO — Paramedics armed with a cheap, three-ingredient injection cocktail were able to reduce heart attack patients' risk of dying by 50 percent, said a US study released on Tuesday.
When the shot was given early to patients with signs of a heart attack, the mixture of glucose, insulin and potassium, or GIK, showed remarkable success in preventing full cardiac arrest — when the heart stops beating — and even death.
And each shot cocktail costs only about $50, according to the research presented at the American College of Cardiology's 61st annual scientific meeting in Chicago.
"When started immediately in the home or on the way to the hospital — even before the diagnosis is completely established — GIK appears to reduce the size of heart attacks and to reduce by half the risk of having a cardiac arrest or dying," said co-principal investigator Harry Selker.
"Because the trial is the first to show GIK is effective when used by paramedics in real-world community settings, it could have important implications for the treatment of heart attacks," added Selker, executive director of the Institute for Clinical Research at Tufts Medical Center.
Previous trials using the formula were inconclusive, possibly because the shot was being given to patients too late, he said.
But this trial, which randomized 911 patients to receive either the shot or a placebo and was carried out by trained paramedics in 13 cities across the United States, showed positive effects in those who were given the treatment.
The treatment did not prevent heart attacks from occurring, but cut the likelihood of cardiac arrest by 50 percent over patients who did not get the shot. The risk of immediate death also dropped by 50 percent.
The effects were visible over the month following the event as well, with patients given the shot 40 percent less likely to die or be hospitalized for heart failure than those who did not.
In patients with a certain kind of heart attack in which a coronary artery becomes completely blocked, known as an ST-elevation heart attack, immediate GIK was associated with a 60 percent reduction in cardiac arrest or death.
Those who got GIK and were later confirmed to have had a heart attack saw an average of two percent of their heart tissue damaged, compared to 10 percent in the placebo group.
While 23 percent of the suspected heart attacks in the study turned out to be false alarms, patients who got the GIK shot showed no negative side effects from the treatment.
The key difference in this trial compared to previous ones appeared to be the act of giving the shot right away, rather than waiting for a confirmed diagnosis at the hospital.
"We wanted to do something that is effective and can be used anywhere," said Selker.
"More people die of heart attacks outside the hospital than inside the hospital. Hundreds of thousands of people per year are dying out in the community; we wanted to direct our attention to those patients."
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Andrew Tucker Friday, March 30, 2012 10:59:18 AM How is the risk of death reduced? Last I checked, in spite of all of medicine's advances, 100% of all people die regardless what is done with them, to them or for them. That first sentence technically says that 50% of people who get this GIK coctail become immortal. 
Ernie Sharp Sunday, April 01, 2012 5:40:32 PM It is a 30 day mortality rate that is used. That is, the percentage of subjects that survived to 30 days after the onset of the event.
Arron Martinez Friday, March 30, 2012 11:09:33 AM Could you please link to, or cite, the study? I'd like to read the actual research. :) 
Chris Cannon Friday, March 30, 2012 11:45:38 AM http://jama.ama-assn.org/content/early/2012/03/21/jama.2012.426.full 
Eric McCallister Friday, March 30, 2012 10:06:41 PM Arron Martinez I think what the article is saying is that no benefits have been observed at all. Seems EMS1 jumped the gun a bit.
Carl W French Sunday, April 01, 2012 5:18:40 PM Eric McCallister You read the sentence and then stopped. Read the entire paragraph. It does not change the progression of the MI by much but the percentage of mortality was lower by a pretty good margin than the placebo.
Andrew Collins Friday, March 30, 2012 3:12:38 PM So this is only for patients having an acute MI or elevated triponins only? 
Brandon Kent Friday, March 30, 2012 4:16:37 PM Link to the study? Sounds like some research to follow! 
Christopher Buechele Friday, March 30, 2012 7:31:58 PM Smart ass. Pretty sure the first sentence stated heart attack patients. Focus on the fact that this may be something great. 
Jeffrey Flanders Saturday, March 31, 2012 5:05:09 AM After reading the article and then the comments I have come to the conclusion that some people love to split hairs. My mom had 4 MAJOR MIs at the age of 39 and lost the complete use of the backside of her heart because of the damage done to it. If something like GIK were around back then and could have reduced the amount of damage even a little, it would have been worth the shot, at least in my book. I think that anything that could reduce damage and give the patient a chance at a better quality of life is worth taking a good look at. My mom managed to live another 20 yrs.before her heart finally gave out, who knows maybe with something like GIK she might still be with us..
I look at the patients that I bring in, that are in the middle of a cardiac event and I wonder if they would choose to not take the chance if they knew about risks vs rewards. Stay focused people, it is all about patient care and outcome in my book. 
Michael H. Reynolds Saturday, March 31, 2012 6:00:51 AM Here is a portion of the Abstract published in JAMA. The link to this Abstract is: http://jama.ama-assn.org/content/early/2012/03/21/jama.2012.426.abstract. The Abstract provides a link to the Clinical Trial using its Identifier, also at the end of my post.
Results: There was no significant difference in the rate of progression to MI among patients who received GIK (n = 200; 48.7%) vs those who received placebo (n = 242; 52.6%) (odds ratio [OR], 0.88; 95% CI, 0.66-1.13; P =.28). Thirty-day mortality was 4.4% with GIK vs 6.1% with placebo (hazard ratio [HR], 0.72; 95% CI, 0.40-1.29; P =.27). The composite of cardiac arrest or in-hospital mortality occurred in 4.4% with GIK vs 8.7% with placebo (OR, 0.48; 95% CI, 0.27-0.85; P =.01). Among patients with ST-segment elevation (163 with GIK and 194 with placebo), progression to MI was 85.3% with GIK vs 88.7% with placebo (OR, 0.74; 95% CI, 0.40-1.38; P =.34); 30-day mortality was 4.9% with GIK vs 7.7% with placebo (HR, 0.63; 95% CI, 0.27-1.49; P =.29). The composite outcome of cardiac arrest or in-hospital mortality was 6.1% with GIK vs 14.4% with placebo (OR, 0.39; 95% CI, 0.18-0.82; P =.01). Serious adverse events occurred in 6.8% (n = 28) with GIK vs 8.9% (n = 41) with placebo (P =.26).
Conclusions Among patients with suspected ACS, out-of-hospital administration of intravenous GIK, compared with glucose placebo, did not reduce progression to MI. Compared with placebo, GIK administration was not associated with improvement in 30-day survival but was associated with lower rates of the composite outcome of cardiac arrest or in-hospital mortality.
Trial Registration clinicaltrials.gov Identifier: NCT00091507. 
Patricia Brandt Saturday, March 31, 2012 1:28:09 PM This treatment was first suggested by a doctor from Mexico over 30 years ago. I thought at the time that it had merit and wondered why something that was simple to administer and had few or no side effects was not pursued. After 40+ years in medicine I have unfortunately come to the conclusion that it is because it is inexpensive and not a patent medication. So sad! 
Jason Washuta Saturday, March 31, 2012 5:42:45 PM It is sad that medicine is about money not about people. :(
Phillip Griffin Sunday, April 01, 2012 5:06:31 PM @ Andrew....and that is why you should never become a medic.... 
Bob Ashley Sunday, April 01, 2012 5:43:41 PM Studies are great, but when something shows it is right, forget more studies and delays when it shows no adverse effects. Science is geeat but don't hamper the resulta!
Dennis J. Long Sunday, April 01, 2012 7:20:37 PM How well known is this study. Been in the business over 30 years, this is the first I.
've heard of it. 
Jonathan Farrow Wednesday, May 30, 2012 12:59:50 PM My service uses glucose and insulin infusions in MI's and based on the electrolytes administers potassium. We have had great success with it. The single shot thing would be nice, we do it with seperate meds and infusion pumps. Just depends on what kind of services you work for.
Brooks Walsh Sunday, April 01, 2012 9:31:30 PM If you read the study, and not just listen to the press release, you would be much less enthusiastic about it.
http://millhillavecommand.blogspot.com/2012/03/immediate-trial-shoukd-ems-give-glucose.html 
Anita Lindsay Monday, April 02, 2012 7:09:11 AM Interesting article. I would like to read the study and results including studdesign, paramedic training, and results, and conclusion before making a decision whether or not I would advocate this. I do agree that more studies are needed. I think this could greatly benefit those in rural areas where transport times are long; if this cardiac cocktail truly does decrease risk of damage and death then it would definity be a worth while investment. 
Bill Matvya Thursday, May 10, 2012 4:05:58 PM Let's.get in the field To all of our Paramedic's, Becouse that's. One more life that can be Saved , And you may never know it could be your mom or dad ,brother,or Sister ,that don't desive To pass on ! Let's go all Doctors in. Chicago My favorite big city get it rolling with out the goverment loop hole s To jump throw ,Put you M.D..s in a great place set the Ground. ! You can do it 
