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. 2021 Sep;110(9):1484-1492.
doi: 10.1007/s00392-021-01862-7. Epub 2021 May 4.

Admission blood glucose level and outcome in patients requiring venoarterial extracorporeal membrane oxygenation

Xavier Bemtgen  1   2 , Jonathan Rilinger  3   4 , Markus Jäckel  3   4 , Viviane Zotzmann  3   4 , Alexander Supady  3   4   5 , Christoph Benk  6 , Christoph Bode  3   4 , Tobias Wengenmayer  3   4 , Achim Lother  3   4 , Dawid L Staudacher  3   4
Affiliations

Admission blood glucose level and outcome in patients requiring venoarterial extracorporeal membrane oxygenation

Xavier Bemtgen et al. Clin Res Cardiol. 2021 Sep.

Abstract

Background: Patients with cardiogenic shock or cardiac arrest undergoing venoarterial extracorporeal membrane oxygenation (V-A ECMO) frequently present with blood glucose levels out of normal range. The clinical relevance of such findings in the context of V-A ECMO is unknown. We therefore investigated the prognostic relevance of blood glucose at time of cannulation for V-A ECMO.

Methods: We conducted a single-center retrospective registry study. All patients receiving V-A ECMO from October 2010 to January 2020 were included if blood glucose level at time of cannulation were documented. Patients were divided in five groups according to the initial blood glucose level ranging from hypoglycemic (< 80 mg/dl), normoglycemic (80-140 mg/dl), to mild (141-240 mg/dl), moderate (241-400 mg/dl), and severe (> 400 mg/dl) hyperglycemia, respectively. Clinical presentation, arterial blood gas analysis, and survival were compared between the groups.

Results: 392 patients met inclusion criteria. Median age was 62 years (51.5-70.0), SAPS II at admission was 54 (43.5-63.0), and 108/392 (27.6%) were female. 131/392 were discharged alive (hospital survival 33.4%). At time of cannulation, survivors had higher pH, hemoglobin, calcium, bicarbonate but lower potassium and lactate levels compared to non-survivors (all p < 0.01). Outcome of patients diagnosed with particularly high (> 400 mg/dl) and low (< 80 mg/dl) blood glucose at time of V-A ECMO cannulation, respectively, was worse compared to patients with normoglycemic, mildly or moderately elevated values (p = 0.02). Glucose was independently associated with poor outcome after adjustment for other predictors of survival and persisted in all investigated subgroups.

Conclusion: Arterial blood glucose at time of V-A ECMO cannulation predicts in-hospital survival of patients with cardiac shock or after ECPR. Whether dysglycemia represents a potential therapeutic target requires further evaluation in prospective studies.

Keywords: Cardiogenic shock; ECPR; Glucose; Survival; V-A ECMO.

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Conflict of interest statement

AS reports research grants and lecture fees from CytoSorbents and lecture fees from Abiomed, both outside the submitted work. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection
Fig. 2
Fig. 2
Survival in relation to different plasma glucose levels. The red stars represent the survival rate of each group, and the blue bars the number of patients per group
Fig. 3
Fig. 3
Kaplan–Meier survival curves. Glucose unit in mg/dl. a and b all patients with different grouping, c only ECPR patients, and d only patients with cardiogenic shock. V-A ECMO venoarterial extracorporeal membrane oxygenation therapy, ECPR extracorporeal cardiopulmonary resuscitation, CS cardiogenic shock
Fig. 4
Fig. 4
Forrest plot of different subgroups. OR Odds ratio, CI confidence interval, ECPR extracorporeal cardiopulmonary resuscitation, CS cardiogenic shock
See this image and copyright information in PMC

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