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. 2009 Jun;80(6):624-30.
doi: 10.1016/j.resuscitation.2009.02.011. Epub 2009 Mar 18.

Derangements in blood glucose following initial resuscitation from in-hospital cardiac arrest: a report from the national registry of cardiopulmonary resuscitation

David G Beiser  1 , Gordon E Carr, Dana P Edelson, Mary Ann Peberdy, Terry L Vanden Hoek
Affiliations

Derangements in blood glucose following initial resuscitation from in-hospital cardiac arrest: a report from the national registry of cardiopulmonary resuscitation

David G Beiser et al. Resuscitation. 2009 Jun.

Abstract

Study aims: Hyperglycemia is associated with poor outcomes in critically ill patients. We examined blood glucose values following in-hospital cardiac arrest (IHCA) to (1) characterize post-arrest glucose ranges, (2) develop outcomes-based thresholds of hyperglycemia and hypoglycemia, and (3) identify risk factors associated with post-arrest glucose derangements.

Methods: We retrospectively studied 17,800 adult IHCA events reported to the National Registry of Cardiopulmonary Resuscitation (NRCPR) from January 1, 2005 through February 1, 2007.

Results: Data were available from 3218 index events. Maximum blood glucose values were elevated in diabetics (median 226 mg/dL [IQR, 165-307 mg/dL], 12.5 mmol/L [IQR 9.2-17.0 mmol/L]) and non-diabetics (median 176 mg/dL [IQR, 135-239 mg/dL], 9.78 mmol/L [IQR 7.5-13.3 mmol/L]). Unadjusted survival to hospital discharge was higher in non-diabetics than diabetics (45.5% [95% CI, 43.3-47.6%] vs. 41.7% [95% CI, 38.9-44.5%], p=0.037). Non-diabetics displayed decreased adjusted survival odds for minimum glucose values outside the range of 71-170 mg/dL (3.9-9.4 mmol/L) and maximum values outside the range of 111-240 mg/dL (6.2-13.3 mmol/L). Diabetic survival odds decreased for minimum glucose greater than 240 mg/dL (13.3 mmol/L). In non-diabetics, arrest duration was identified as a significant factor associated with the development of hypo- and hyperglycemia.

Conclusions: Hyperglycemia is common in diabetics and non-diabetics following IHCA. Survival odds in diabetics are relatively insensitive to blood glucose with decreased survival only associated with severe (>240 mg/dL, >13.3 mmol/dL) hyperglycemia. In non-diabetics, survival odds were sensitive to hypoglycemia (<70 mg/dL, <3.9 mmol/L).

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Figures

Figure 1
Figure 1
Selection of glucose analysis group. From the initial 17,800 cardiac arrest events available, 15,410 represented index events. Of this group, 8,172 patients achieved initial ROSC. Analysis was performed on the group of 3,218 patients who had minimum and maximum blood glucose data.
Figure 2
Figure 2
Distribution (A, B) (%) and survival to hospital discharge rates (C, D) (%) of non-diabetic and diabetic patients across maximum and minimum glucose quantiles. A significantly higher proportion of diabetics exhibited maximum glucose values over 240 mg/dL (13.3 mmol/L) as compared to non-diabetics (45.6% vs. 24.4% respectively, p < 0.001).
Figure 3
Figure 3
Adjusted survival to hospital discharge by minimum and maximum post-arrest glucose value for (A) non-diabetics and (B) diabetics. Odds ratios calculated using multivariate logistic regression model comprised of clinical variables from Table 1.
See this image and copyright information in PMC

Comment in

  • Glucose control after cardiac arrest.
    Padkin A. Padkin A. Resuscitation. 2009 Jun;80(6):611-2. doi: 10.1016/j.resuscitation.2009.04.019. Resuscitation. 2009. PMID: 19460604 No abstract available.

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