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Strict versus moderate glucose control after resuscitation from ventricular fibrillation

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Abstract

Objective

Elevated blood glucose is associated with poor outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Our aim was to determine whether strict glucose control with intensive insulin treatment improves outcome of OHCA patients.

Design

A randomized, controlled trial.

Setting

Two university hospital intensive care units.

Patients

Ninety patients resuscitated from OHCA with ventricular fibrillation detected as the initial rhythm were treated with therapeutic hypothermia.

Interventions

Patients were randomized into two treatment groups: a strict glucose control group (SGC group), with a blood glucose target of 4–6 mmol/l, or a moderate glucose control group (MGC group), with a blood glucose target of 6–8 mmol/l. Both groups were treated with insulin infusion for 48 h, because a control group with no treatment was considered unethical.

Measurements and results

Baseline data were similar in both groups. In the SGC group 71% of the glucose measurements were within the target range compared with 41% in the MGC group. Median glucose was 5.0 mmol/l in the SGC group and 6.4 mmol/l in the MGC group. The occurrence of moderate hypoglycemic episodes was 18% in the SGC group and 2% in the MGC group (p = 0.008). No episodes of severe hypoglycemia occurred. Mortality by day 30 was 33% in the SGC group and 35% in the MGC group (p = 0.846); the difference was 2% (95% CI –18% to +22%).

Conclusions

We found no additional survival benefit from strict glucose control compared with moderate glucose control with a target between 6 and 8 mmol/l in OHCA patients.

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References

  1. Herlitz J, Castren M, Friberg H, Nolan JP, Skrifvars MB, Sunde K, Steen P (2006) Post resuscitation care: what are the therapeutic alternatives and what do we know? Resuscitation 69:15–22

    Article  PubMed  CAS  Google Scholar 

  2. Nolan JP, Deakin CD, Soar J, Böttiger BW, Smith G (2005) European Resuscitation Council Guidelines for Resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 67:S39–S86

    Article  PubMed  Google Scholar 

  3. Langhelle A, Tyvold S, Lexow K, Hapnes S, Sunde K, Steen P (2003) In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway. Resuscitation 56:247–263

    Article  PubMed  CAS  Google Scholar 

  4. Skrifvars MB, Pettilä V, Rosenberg PH, Castren M (2003) A multiple logistic regression analysis of in-hospital factors related to survival at six months in patients resuscitated from out-of-hospital ventricular fibrillation. Resuscitation 59:319–328

    Article  PubMed  CAS  Google Scholar 

  5. HACA Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556

    Article  Google Scholar 

  6. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563

    Article  PubMed  Google Scholar 

  7. Nolan JP, Morley PT, Vanden Hoek TL, Hickey RW (2003) Therapeutic hypothermia after cardiac arrest. An advisory statement by the advanced life support task force of the international liaison committee on resuscitation. Circulation 108:118–121

    Article  PubMed  CAS  Google Scholar 

  8. Van den Berghe G, Wouters PJ, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlaesselaers D, Ferdinande P, Lauwers P, Bouillon R (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367

    Article  PubMed  Google Scholar 

  9. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354:449–461

    Article  PubMed  Google Scholar 

  10. Meynaar I, Oudemans-van Straaten H, van der Wetering J, Verlooy P, Slaats E, Bosman R, van der Spoel J, Zandstra D (2003) Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study. Intensive Care Med 29:189–195

    PubMed  Google Scholar 

  11. Schoerkhuber W, Kittler H, Sterz F, Behringer W, Holzer M, Frossard M, Spitzauer S, Laggner A (1999) Time course of serum neuron-specific enolase: a predictor of neurological outcome in patients resuscitated from cardiac arrest. Stroke 30:1598–1603

    PubMed  CAS  Google Scholar 

  12. Rosén H, Stibrant Sunnerhagen K, Herlitz J, Blomstrand C, Rosengren L (2001) Serum level of the brain-derived proteins S-100 and NSE predict long-term outcome after cardiac arrest. Resuscitation 49:183–191

    Article  PubMed  Google Scholar 

  13. Tiainen M, Roine RO, Pettilä V, Takkunen O (2003) Serum neuron-specific enolase and S-100B protein in cardiac arrest patients treated with hypothermia. Stroke 34:2881–2886

    Article  PubMed  CAS  Google Scholar 

  14. De Latorre F, Nolan JP, Robertson C, Chamberlain D, Baskett P (2001) European Resuscitation Council guidelines 2000 for adult advanced life support. Resuscitation 48:211–221

    Article  PubMed  Google Scholar 

  15. Longstreth W, Inui T (1984) High blood glucose level on hospital admission and poor neurological recovery after cardiac arrest. Ann Neurol 15:59–63

    Article  PubMed  Google Scholar 

  16. Müllner M, Sterz F, Binder M, Schreiber W, Deimel A, Laggner AN (1997) Blood glucose concentration after cardiopulmonary resuscitation influences functional neurological recovery in human cardiac arrest survivors. J Cereb Blood Flow Metab 17:430–436

    Article  PubMed  Google Scholar 

  17. Preiser J-C, Devos P (2007) Steps for the implementation and validation of tight glucose control. Intensive Care Med 33:570–571

    Article  PubMed  Google Scholar 

  18. Van den Berghe G, Wilmer A, Milants I, Wouters PJ, Bouckaert B, Bruyninckx F, Bouillon R, Schetz M (2006) Intensive insulin therapy in mixed medical/surgical intensive care units. Benefit versus harm. Diabetes 55:3151–3159

    Article  PubMed  Google Scholar 

  19. Finney SJ, Zekveld C, Elia A, Evans TW (2003) Glucose control and mortality in critically ill patients. JAMA 290:2041–2047

    Article  PubMed  CAS  Google Scholar 

  20. Vriesendorp T, DeVries J, van Santen S, Moeniralam H, de Jonge E, Roos Y, Schultz M, Rosendaal F, Hoekstra J (2006) Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Crit Care Med 34:2714–2718

    Article  PubMed  CAS  Google Scholar 

  21. Brunkhorst FM, Kuhnt E, Engel C, Meier-Hellmann A, Ragaller M, Quintel M et al. (2005) Intensive insulin therapy in patient with severe sepsis and septic shock is associated with an increased rate of hypoglycemia—results from a randomized multicenter study (VISEP). Infection 33:19–20

    Google Scholar 

  22. Brunkhorst FM, Reinhart K (2007) Intensive insulin therapy in the ICU: benefit versus harm? Intensive Care Med 33:1302

    Article  PubMed  CAS  Google Scholar 

  23. Kanji S, Singh A, Tierney M, Meggison H, McIntyre L, Hebert PC (2004) Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults. Intensive Care Med 30:804–810

    Article  PubMed  Google Scholar 

  24. Meynaar IA, Dawson L, Tangkau PL, Salm EF, Rijks L (2007) Introduction and evaluation of a computerised insulin protocol. Intensive Care Med 33:591–596

    Article  PubMed  Google Scholar 

  25. Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C, Draegni T, Steen PA (2007) Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 73:29–39

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank for funding the Laerdal Foundation and the Instrumentarium Foundation, and for data collection the medical student Erkko Klemetti, and the study nurses Pia Simon, Nina Nakari, Leena Pettilä, Kirsi Ruohomäki, and Teemu Hult and the ICU personnel in the Jorvi and Meilahti hospitals.

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Correspondence to Tuomas Oksanen.

Additional information

Descriptor: 21. Cardiopulmonary resuscitation

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Oksanen, T., Skrifvars, M.B., Varpula, T. et al. Strict versus moderate glucose control after resuscitation from ventricular fibrillation. Intensive Care Med 33, 2093–2100 (2007). https://doi.org/10.1007/s00134-007-0876-8

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  • DOI: https://doi.org/10.1007/s00134-007-0876-8

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