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Blood glucose level and outcome after cardiac arrest: insights from a large registry in the hypothermia era

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Abstract

Introduction

The influence of blood glucose (BG) level during the post-resuscitation period after out-of-hospital cardiac arrest (OHCA) is still debated. To evaluate the relationship between blood glucose level and outcome, we included the median glycemia and its maximal amplitude over the first 48 h following ICU admission in an analysis of outcome predictors.

Methods

We conducted a database study in a cardiac arrest center in Paris, France. Between 2006 and 2010, we included 381 patients who were all resuscitated from an OHCA. A moderate glycemic control was applied in all patients. The median glycemia and the largest change over the first 48 h were included in a multivariate analysis that was performed to determine parameters associated with a favorable outcome.

Results

Of the 381 patients, 136 (36 %) had a favorable outcome (CPC 1–2). Median BG level was 7.6 mmol/L (6.3–9.8) in patients with a favorable outcome compared to 9.0 mmol/L (IQR 7.1–10.6) for patients with an unfavorable outcome (p < 0.01). Median BG level variation was 7.1 (4.2–11) and 9.6 (5.9–13.6) mmol/L in patients with and without a favorable outcome, respectively (p < 0.01). In multivariate analysis, an increased median BG level over the first 48 h was found to be an independent predictor of poor issue [OR = 0.43; 95 % CI (0.24–0.78), p = 0.006]. Finally a progressive increase in median BG level was associated with a progressive increase in the proportion of patients with a poor outcome.

Conclusion

We observed a relationship between high blood glucose level and outcome after cardiac arrest. These results suggest the need to test a strategy combining both control of glycemia and minimization of glycemic variations for its ability to improve post-resuscitation care.

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Conflicts of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France

    Fabrice Daviaud, Nadège Demars, Guillaume Geri, Adrien Bouglé, Tristan Morichau-Beauchant, Yên-Lan Nguyen, Wulfran Bougouin, Frédéric Pène, Julien Charpentier & Alain Cariou

  2. Emergency Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France

    Florence Dumas

  3. Paris Descartes University, Paris, France

    Fabrice Daviaud, Florence Dumas, Guillaume Geri, Adrien Bouglé, Tristan Morichau-Beauchant, Yên-Lan Nguyen, Wulfran Bougouin, Frédéric Pène, Julien Charpentier & Alain Cariou

  4. INSERM U970 (Team 4), 56 rue Leblanc, 75015, Paris, France

    Florence Dumas & Alain Cariou

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  1. Fabrice Daviaud
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Corresponding author

Correspondence to Alain Cariou.

Additional information

Take-home message: The role of glycemia during the post-resuscitation period in cardiac arrest patients is unknown. In this study we found that a high level of glycemia during the first 48 h following a cardiac arrest was associated with a poor outcome.

Electronic supplementary material

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Supplementary material Fig. 1: decision algorithm for post-CA patients (DOCX 343 kb)

134_2014_3269_MOESM2_ESM.doc

Supplementary material Table 1: insulin administration protocol. Outcome assessment and life support treatment withdrawal (DOC 31 kb)

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Daviaud, F., Dumas, F., Demars, N. et al. Blood glucose level and outcome after cardiac arrest: insights from a large registry in the hypothermia era. Intensive Care Med 40, 855–862 (2014). https://doi.org/10.1007/s00134-014-3269-9

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  • DOI: https://doi.org/10.1007/s00134-014-3269-9

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