Article

Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12h after cardiac arrest might not be necessary

Department of Emergency Medicine, Medical University of Vienna, Austria.
Resuscitation (Impact Factor: 3.96). 03/2008; 76(2):214-20. DOI: 10.1016/j.resuscitation.2007.08.003
Source: PubMed

ABSTRACT The admission blood glucose level after cardiac arrest is predictive of outcome. However the blood glucose levels in the post-resuscitation period, that are optimal remains a matter of debate. We wanted to assess an association between blood glucose levels at 12h after restoration of spontaneous circulation and neurological recovery over 6 months.
A total of 234 patients from a multi-centre trial examining the effect of mild hypothermia on neurological outcome were included. According to the serum glucose level at 12h after restoration of spontaneous circulation, quartiles (Q) were generated: Median (range) glucose concentrations were for QI 100 (67-115 mg/dl), QII 130 (116-143 mg/dl), QIII 162 (144-193 mg/dl) and QIV 265 (194-464 mg/dl).
In univariate analysis there was a strong non-linear association between blood glucose and good neurological outcome (odds ratio compared to QIV): QI 8.05 (3.03-21.4), QII 13.41 (4.9-36.67), QIII 1.88 (0.67-5.26). After adjustment for sex, age, "no-flow" and "low-flow" time, adrenaline (epinephrine) dose, history of coronary artery disease and myocardial infarction, and therapeutic hypothermia, this association still remained strong: QI 4.55 (1.28-16.12), QII 13.02 (3.29-49.9), QIII 1.37 (0.38-5.64).
There is a strong non-linear association of survival with good neurological outcome and blood glucose levels 12h after cardiac arrest even after adjusting for potential confounders. Not only strict normoglycaemia, but also blood glucose levels from 116 to 143 mg/dl were correlated with survival and good neurological outcome, which might have an important therapeutic implication.

0 Followers
 · 
93 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJETIVO: Conhecer as características dos pacientes submetidos a um protocolo operacional padrão institucional de atendimento a pacientes reanimados após episódio de parada cardiorrespiratória incluindo a aplicação de hipotermia terapêutica. MÉTODOS: Foram analisados retrospectivamente 26 pacientes consecutivos após episódio de parada cardiorrespiratória de janeiro de 2007 a novembro de 2008. RESULTADOS: Todos os casos foram submetidos a hipotermia terapêutica. Idade média de 63 anos, predominantemente do sexo masculino. O local da parada cardiorrespiratória foi extra-hospitalar em 8 casos, pronto socorro em 3, durante internação fora da unidade de terapia intensiva em 13 casos e o bloco cirúrgico em 2 casos. O ritmo de parada foi fibrilação ventricular em sete pacientes, assistolia em 11, atividade elétrica sem pulso em 5 casos e não foi determinado em 3 pacientes. O intervalo entre a parada e o retorno à circulação espontânea foi de 12 ± 5 minutos. O tempo requerido para alcançar a temperatura alvo foi de 5 ± 4 horas, o tempo de hipotermia foi de 22 ± 6 horas e para o reaquecimento usaram-se 9 ± 5,9 horas. Catorze pacientes evoluíram a óbito na unidade de terapia intensiva, representando uma mortalidade de 54%, e três pacientes tiveram o mesmo desfecho durante a internação, determinando uma mortalidade intra-hospitalar de 66%. Houve redução estatisticamente significativa dos valores de hemoglobina (p <0,001), leucócitos (p=0,001), plaquetas (p<0,001), lactato (p<0,001) e potássio (p=0,009), e aumento de proteína C reativa (p=0,001) e RNI (p=0,004) após aplicação de hipotermia. CONCLUSÕES: A elaboração de protocolo operacional padrão de hipotermia terapêutica para o tratamento de pacientes com parada cardiorrespiratória, utilizando-se das rotinas adaptadas de estudos randomizados, resultou em elevada aderência e seus resultados assemelham-se aos dados publicados na literatura.
    Revista Brasileira de Terapia Intensiva 12/2009; 21(4):369-375. DOI:10.1590/S0103-507X2009000400006
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background It is well known that hyperglycemia is associated with poor outcomes in critically ill patients. We investigated the association between blood glucose level at admission and the outcomes of patients treated with therapeutic hypothermia after cardiac arrest. Methods A total of 883 cardiac arrest patients who were treated with therapeutic hypothermia were analyzed from the Korean Hypothermia Network (KORHN) retrospective registry. We examined the association of blood glucose at admission with survival and neurologic outcomes at hospital discharge. Favorable neurologic outcomes were defined as CPC scores of 1 and 2. Results The mean age of the sample was 56.7 ± 16.2 years, 69.5% of subjects were male, and the mean blood glucose at admission was 14.1 ± 7.0 mmol/L. After adjustment for sex, age, history of diabetes mellitus, hypertension, renal disease and stroke, time from arrest to ROSC, initial rhythm, witness status, bystander CPR, cause of arrest and cumulative dose of adrenaline, the associations between glucose and outcomes were as follows: for favorable neurologic outcomes, an OR of 0.955 (95% CI, 0.918-0.994); and for survival, an OR of 0.974 (95% CI, 0.952-0.996). Conclusion These results show that blood glucose level at admission is associated with survival and favorable neurologic outcomes at hospital discharge in patients treated with therapeutic hypothermia after cardiac arrest. Blood glucose level at admission could be a surrogate marker of ischemic insult severity during cardiac arrest. However, randomized, controlled evidence is needed to address the significance of tight glucose control during therapeutic hypothermia after cardiac arrest.
    Resuscitation 05/2014; 32(8). DOI:10.1016/j.ajem.2014.05.004 · 3.96 Impact Factor