The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia

Background: The optimal blood glucose target during the early hospitalisation of comatose survivors of out-of-hospital cardiac arrest (OHCA) has not been established. Methods: In a retrospective cohort study, we examined clinical outcomes in relation to mean blood glucose during the first 96 hours of hospital admission in comatose survivors of OHCA with an initial shockable rhythm. Mean blood glucose was assessed as a continuous (primary analysis) and categorical variable: <6 mmol/L, 6 to <8 mmol/L and ⩾8 mmol/L. Co-primary outcomes were the rates of death during the index hospitalisation and severe neurological dysfunction at discharge. We used multivariable logistic regression analyses to adjust for baseline differences in patient and index event characteristics. Results: Among 122 eligible patients, death and severe neurological dysfunction occurred in 29 (24%) and 40 (33%) patients, respectively. Higher mean blood glucose levels during the first 96 hours of admission were associated with increased odds of death (odds ratio (OR): 1.50; 95% confidence interval (CI): 1.17–1.92; p = 0.001) and severe neurological dysfunction (OR: 1.42; 95% CI: 1.11–1.80; p = 0.004). The associations between mean blood glucose and the odds of death (OR: 1.35; 95% CI: 1.04–1.76; p = 0.02) and severe neurological dysfunction (OR: 1.28; 95% CI: 1.00–1.64; p = 0.05) persisted after adjusting for age, time from cardiac arrest to return of spontaneous circulation (ROSC) and vasoactive agent use. There was no interaction between age, time from cardiac arrest to ROSC or a history of diabetes mellitus and the relationship between mean blood glucose and co-primary outcomes. Conclusions: In comatose survivors of OHCA with initial shockable rhythms, higher mean blood glucose levels during the first 96 hours of admission are associated with increased rates of death and severe neurological dysfunction.

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Changes in Therapeutic Hypothermia and Coronary Intervention Provision and In-hospital Mortality of Patients With Out-of-Hospital Cardiac Arrest

Survey of Anesthesiology ◽

10.1097/01.sa.0000504588.25198.e1 ◽

2016 ◽

Vol 60 (6) ◽

pp. 229-230

Author(s):

T. Tagami ◽

H. Matsui ◽

K. Fushimi ◽

H. Yasunaga

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Therapeutic Hypothermia ◽

Coronary Intervention ◽

Hospital Cardiac Arrest

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Elevated Blood Glucose Levels May Increase the Danger of Neurological Deficit Following Profoundly Hypothermic Cardiac Arrest

Anesthesiology ◽

10.1097/00000542-198804000-00051 ◽

1988 ◽

Vol 68 (4) ◽

pp. 653-653 ◽

Cited By ~ 39

Author(s):

DAVID J. STEWARD ◽

CARLOS A. DA SILVA ◽

TED FLEGEL

Keyword(s):

Cardiac Arrest ◽

Blood Glucose ◽

Neurological Deficit ◽

Elevated Blood ◽

Glucose Levels ◽

Elevated Blood Glucose ◽

Blood Glucose Levels

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THE RELATIONSHIP BETWEEN ADMISSION BLOOD GLUCOSE LEVELS AND HOSPITAL MORTALITY

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/924 ◽

2013 ◽

Vol 2 (27) ◽

pp. 4872-4876

Author(s):

Madhumathi R ◽

Rajiv E ◽

Amogh Dudhwewala ◽

Kavya S. T ◽

Srinivasa V

Keyword(s):

Blood Glucose ◽

Hospital Mortality ◽

Glucose Levels ◽

Blood Glucose Levels ◽

The Relationship

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Association of blood glucose levels with in-hospital mortality and 30-day readmission in patients undergoing invasive cardiovascular surgery

Current Medical Research and Opinion ◽

10.1185/03007995.2012.718268 ◽

2012 ◽

Vol 28 (10) ◽

pp. 1657-1665 ◽

Cited By ~ 4

Author(s):

Lauren J. Lee ◽

Matthew F. Emons ◽

Sherry A. Martin ◽

Douglas Faries ◽

Jay Bae ◽

...

Keyword(s):

Blood Glucose ◽

Hospital Mortality ◽

Cardiovascular Surgery ◽

Glucose Levels ◽

Blood Glucose Levels

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Changes in Therapeutic Hypothermia and Coronary Intervention Provision and In-Hospital Mortality of Patients With Out-of-Hospital Cardiac Arrest

Critical Care Medicine ◽

10.1097/ccm.0000000000001401 ◽

2016 ◽

Vol 44 (3) ◽

pp. 488-495 ◽

Cited By ~ 14

Author(s):

Takashi Tagami ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

Hideo Yasunaga

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Therapeutic Hypothermia ◽

Coronary Intervention ◽

Hospital Cardiac Arrest

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Hypoglycemia as a cause of sudden cardiac arrest during cesarean delivery under spinal anesthesia: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-02976-2 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Temesgen Tilahun ◽

Guteta Gudina

Keyword(s):

Cardiac Arrest ◽

Blood Glucose ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Sudden Cardiac Arrest ◽

Rare Event ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Patients At Risk ◽

Poor Outcomes

Abstract Background Sudden cardiac arrest during spinal anesthesia is a rare event. However, its management by an unprepared team is difficult and carries poor outcomes. Hypoglycemia as the cause of sudden cardiac arrest is rarely reported. This case illustrates lifesaving procedures for sudden cardiac arrest secondary to hypoglycemia during cesarean delivery under spinal anesthesia. Case summary We report a case, from rural Ethiopia of sudden cardiac arrest secondary to hypoglycemia during cesarean delivery under spinal anesthesia. The case was successfully managed by a team of anesthetists and other operating teams. The mother and newborn were discharged from the hospital on the 7th postoperative day. Conclusion Hypoglycemia during cesarean delivery under spinal anesthesia can cause sudden cardiac arrest. Therefore, identifying patients at risk of developing hypoglycemia, monitoring the patient’s condition, and initiating prompt intervention at the first sign of cardiovascular instability is advisable. Determining serum blood glucose levels at admission to the labor ward and monitoring blood glucose levels during spinal anesthesia should be routine practices.

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Blood Glucose Concentration after Cardiopulmonary Resuscitation Influences Functional Neurological Recovery in Human Cardiac Arrest Survivors

Journal of Cerebral Blood Flow & Metabolism ◽

10.1097/00004647-199704000-00008 ◽

1997 ◽

Vol 17 (4) ◽

pp. 430-436 ◽

Cited By ~ 109

Author(s):

Marcus Müllner ◽

Fritz Sterz ◽

Michael Binder ◽

Wolfgang Schreiber ◽

Alexander Deimel ◽

...

Keyword(s):

Cardiac Arrest ◽

Blood Glucose ◽

Glucose Concentration ◽

Neurological Outcome ◽

Blood Glucose Concentration ◽

Neurological Recovery ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Poor Neurological Outcome ◽

Blood Glucose Concentrations

Experimental data suggest that postischemic blood glucose concentration plays an important role in modulating both ischemic cerebral infarction and selective neuronal necrosis. This study investigated the association between functional neurological recovery and blood glucose concentrations in human cardiac arrest survivors. A group of 145 nondiabetic patients were evaluated after witnessed ventricular fibrillation cardiac arrest. Data regarding cardiac arrest were collected according to an internationally accepted protocol immediately after arrival. Blood glucose was measured on admission and 6, 12, and 24 h thereafter. To control for duration of cardiac arrest and cardiogenic shock, both known to influence outcome as well as blood glucose, levels, Spearman rank partial correlation was used. In this multivariate analysis, a high admission blood glucose level tended to be associated with poor neurological outcome ( rs = −0.16, n = 142, p = 0.06). The association between high median blood glucose levels over 24 h and poor neurological outcome was strong and statistically significant ( rs = −0.2, n = 145, p = 0.015). High blood glucose concentrations occurring over the first 24 h after cardiac arrest have deleterious effects on functional neurological recovery. Whether cardiac arrest survivors might benefit from reduction of blood glucose levels needs further investigation.

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