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Associations between intra-arrest blood glucose level and outcomes of adult in-hospital cardiac arrest: A 10-year retrospective cohort study

  • Chih-Hung Wang
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Wei-Tien Chang
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Chien-Hua Huang
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Min-Shan Tsai
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Eric Chou
    Affiliations
    Department of Emergency Medicine, Baylor Scott&White All Saints Medical Center, Fort Worth, TX, USA
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  • Ping-Hsun Yu
    Affiliations
    Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
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  • Yen-Wen Wu
    Affiliations
    Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Author Footnotes
    1 The corresponding author had full access to all data and final responsibility to submit the results for publication.
    Wen-Jone Chen
    Correspondence
    Corresponding author at: No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan.
    Footnotes
    1 The corresponding author had full access to all data and final responsibility to submit the results for publication.
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
    Search for articles by this author
  • Author Footnotes
    1 The corresponding author had full access to all data and final responsibility to submit the results for publication.

      Abstract

      Aim

      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.

      Methods

      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.

      Results

      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.

      Conclusion

      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.

      Keywords

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