BACKGROUND:
Hyperglycemia is associated with poor outcomes in a variety of critically-ill patient populations; however, little is known about the role of hyperglycemia in determining outcomes following in-hospital cardiac arrest (IHCA).
METHODS:
We performed a retrospective analysis of 17,800 adult in-hospital cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Minimum and maximum blood glucose values during the first 24 hours following return of spontaneous circulation (ROSC) were examined.
RESULTS:
Glucose data from 3,226 patients were available for analysis. Post-ROSC maximum blood glucose values were markedly elevated in diabetic (median, 226 mg/dL, [IQR, 165 – 307 mg/dL)] as well as non-diabetic patients (176 mg/dL, 135 – 239 mg/dL). 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). In non-diabetics, survival to hospital discharge varied significantly when stratified by glucose value with optimal survival odds occurring across a broad range of minimum (71 – 170 mg/dL) and maximum (111 – 240 mg/dL) glucose values. Cardiac arrest duration quartile was identified as a significant factor associated with the development of post-ROSC hypo- and hyperglycemia in non-diabetics.
CONCLUSIONS:
Derangements in blood glucose are common following IHCA in both diabetic and non-diabetic patients. Optimal survival odds occur across a relatively broad range of glucose values in non-diabetics; however, both hypo- and hyperglycemia are associated with worse outcomes and associated with longer arrest durations.
The national registry of cardiopulmonary resuscitation: a preliminary report of 5,030 adult in-hospital cardiac arrests
