We attempted to examine the association between intra-arrest blood glucose (BG) level and outcomes of in-hospital cardiac arrest (IHCA). The interaction between diabetes mellitus (DM) and BG level as well as between dextrose administration and BG level were investigated.
This single-centred retrospective study reviewed IHCA patients between 2006 and 2015. Patients with measured intra-arrest BG levels were included. Multivariable logistic regression analyses were conducted. Generalised additive models were used to identify appropriate cut-off points for continuous variables. Interactions between independent variables were assessed during the model-fitting process.
Among the 580 included patients, 34 (5.9%) achieved neurologically intact survival. There were 197 DM patients (34.0%). The mean intra-arrest BG level was 191.5 mg/dl, with 57 patients (9.8%) experiencing hypoglycaemia (BG level ≤ 70 mg/dl). A total of 165 patients (28.4%) received a dextrose injection. An intra-arrest BG level ≤ 150 mg/dl was inversely associated with favourable neurological outcomes at hospital discharge (odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.11–0.73; p-value = 0.01). In analyses of interactions, non-DM × BG level ≤ 168 mg/dl was inversely associated with favourable neurological outcomes (OR: 0.30, 95% CI: 0.11–0.80; p-value = 0.02). There were no significant interactions between BG level and dextrose administration.
IHCA patients with intra-arrest BG level ≤ 150 mg/dl had worse neurological recovery. Intra-arrest hypoglycaemia might be a marker of critical illness. Dextrose administration was not shown to improve outcomes of IHCA patients with intra-arrest BG level ≤ 150 mg/dl, indicating the need to develop new therapeutics other than dextrose administration for these patients.
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- Heart disease and stroke statistics—2017 update: a report from the American Heart Association.Circulation. 2017; 135: e146-e603
- Part 7.2: management of cardiac arrest.Circulation. 2005; 112 (IV-58–IV-66)
- Part 8: adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2010; 122: S729-S767
- Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2015; 132: S444-S464
- Trends over time in drug administration during adult in-hospital cardiac arrest.Crit Care Med. 2019; 47: 194-200
- The administration of dextrose during in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity.Crit Care. 2015; 19: 160
- Hypoglycemia and risk of death in critically ill patients.N Engl J Med. 2012; 367: 1108-1118
- Associations between blood glucose level and outcomes of adult in-hospital cardiac arrest: a retrospective cohort study.Cardiovasc Diabetol. 2016; 15: 118
- Derangements in blood glucose following initial resuscitation from in-hospital cardiac arrest: a report from the national registry of cardiopulmonary resuscitation.Resuscitation. 2009; 80: 624-630
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).Circulation. 2004; 110: 3385-3397
- Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia.Diabetes Care. 2005; 28: 1245-1249
- Primary outcomes for resuscitation science studies: a consensus statement from the American Heart Association.Circulation. 2011; 124: 2158-2177
- Generalized additive models.Chapman & Hall, London and New York1990
- The comatose patient.JAMA. 1975; 233: 1313-1314
- 50% dextrose: antidote or toxin?.Ann Emerg Med. 1990; 19: 683-687
- Intravenous glucose after out-of-hospital cardiopulmonary arrest: a community-based randomized trial.Neurology. 1993; 43: 2534-2541
- The cost of dichotomising continuous variables.BMJ. 2006; 332: 1080
- Severe hypoglycemia-induced lethal cardiac arrhythmias are mediated by sympathoadrenal activation.Diabetes. 2013; 62: 3570-3581
- Stress hyperglycaemia.Lancet. 2009; 373: 1798-1807
- Glucose metabolism and catecholamines.Crit Care Med. 2007; 35: S508-S518
- Glucocorticoids and insulin resistance: old hormones, new targets.Clin Sci (Lond). 1999; 96: 513-523
- Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest.Intensive Care Med. 2005; 31: 627-633
- Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest: a randomized clinical trial.JAMA. 2013; 310: 270-279
- Relative adrenal insufficiency in post-cardiac arrest shock is under-recognized.Resuscitation. 2008; 76: 221-225
Published online: November 28, 2019
Accepted: November 16, 2019
Received in revised form: October 14, 2019
Received: August 2, 2019
Publication stageIn Press Journal Pre-Proof
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