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
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.
Available from: PubMed Central
- "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 . "
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ABSTRACT: Survival rates following in-hospital and out-of-hospital cardiac arrests remain disappointingly low. Organ injury caused by ischemia and hypoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when a spontaneous circulation is restored. A bundle of procedures, which may need to be administered simultaneously, is required. The procedures include prompt identification and treatment of the cause of cardiac arrest, as well as a definitive airway and ventilation together. Additional benefit is possible with appropriate forms of early goal-directed therapy and achieving therapeutic hypothermia within the first few hours, followed by gradual rewarming and ensuring glycaemic control to be within a range of 6 to 10 mmol/L. All these would be important and need to be continued for at least 24 hours. Previous studies have showed that the effects of Shen-Fu injection (SFI) are based on aconitine properties, supplemented by ginsenoside, which can scavenge free radicals, improve energy metabolism, inhibit inflammatory mediators, suppress cell apoptosis, and alleviate mitochondrial damage. SFI, like many other complex prescriptions of traditional Chinese medicine, was also found to be more effective than any of its ingredient used separately in vivo. As the postresuscitation care bundle is known to be, the present paper focuses on the role of SFI played on the postresuscitation care bundle.
Evidence-based Complementary and Alternative Medicine 08/2013; 2013(4):319092. DOI:10.1155/2013/319092 · 1.88 Impact Factor
- "Only one-third of the patients resuscitated from cardiac arrest and admitted to intensive care units survive to discharge from hospital (1). In observational studies, hyperglycemia during intensive care predicted unfavorable outcome (2,3). The aims of this study were to investigate 1) how blood glucose changes during the early postresuscitation period and 2) how changes in blood glucose affect survival in patients resuscitated from out-of-hospital ventricular fibrillation. "
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ABSTRACT: To describe the trend of blood glucose immediately after successful resuscitation from out-of-hospital ventricular fibrillation.
Data from cardiac arrest registry supplemented with blood glucose data were analyzed in this population-based observational study. Between 2005 and 2009, a total of 170 adult patients survived to hospital admission after resuscitation from bystander-witnessed cardiac arrest of cardiac origin and ventricular fibrillation as an initial rhythm.
Sufficient data for analysis were available in 134 (79%) patients, of whom 87 (65% [95% CI 57-73]) survived to hospital discharge in Cerebral Performance Category 1 or 2. Blood glucose did not change significantly between prehospital (10.5 ± 4.1 mmol/L) and admission (10.0 ± 3.7 mmol/L) in survivors (P = 0.3483), whereas in nonsurvivors, blood glucose increased from 11.8 ± 4.6 to 13.8 ± 3.3 mmol/L (P = 0.0025).
Patients who are resuscitated from out-of-hospital ventricular fibrillation, but whose outcome is unfavorable are characterized by significant increase of blood glucose in the ultraacute postresuscitation phase.
Diabetes care 03/2012; 35(3):510-2. DOI:10.2337/dc11-1478 · 8.42 Impact Factor
Available from: Monica E Kleinman
- "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)   . "
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ABSTRACT: Cardiac arrest in infants and children is a rare but critical event that typically follows a period of respiratory or circulatory compromise and has a low survival rate. The only intervention demonstrated to increase survival rate is the provision of bystander CPR. This article examines the pathophysiology of the postarrest reperfusion state; postresuscitation care of the respiratory and cardiovascular systems; postresuscitation neurologic management; therapeutic hypothermia; blood glucose control; immunologic disturbances and infections; coagulation abnormalities; and gastrointestinal and hepatic dysfunction, among other topics.
Pediatric Clinics of North America 09/2008; 55(4):943-67, xi. DOI:10.1016/j.pcl.2008.04.011 · 2.12 Impact Factor
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