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: 4.17). 03/2008; 76(2):214-20. DOI: 10.1016/j.resuscitation.2007.08.003
Source: PubMed


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.

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    • "Blood glucose concentrations must be monitored frequently in these patients, and hyperglycemia should be treated with an insulin infusion. A target glucose range with an upper value of 8.0 mmol/L (144 mg/dL) has been suggested by others [29–31]. The lower value of 6.1 mmol/L (110 mg/dL) may not reduce mortality any further but instead may expose patients to the potentially harmful effects of hypoglycemia [29]. "
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    Evidence-based Complementary and Alternative Medicine 08/2013; 2013(4):319092. DOI:10.1155/2013/319092 · 1.88 Impact Factor
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    • "Recent studies in adults experiencing out-of-hospital cardiac arrest indicate that post–cardiac arrest patients may be treated optimally by maintaining blood glucose concentration below 8 mmol/L (144 mg/dL) [69] [70] [71]. "
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