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

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. Graphical Abstract

Reply to: association between stress hyperglycemia on admission and unfavorable neurological outcome in OHCA patients receiving ECPR (https://doi.org/10.1007/s00392-022-02057-4)

“…This U-shaped association of blood glucose at admission on in-hospital mortality is also present in patients with cardiogenic shock [5]. The same correlation between extreme blood glucose levels and prognosis was shown in patients on venoarterial ECMO with and without ECPR [6]. A U-shaped correlation of glucose with adverse outcome is reasonable from a pathophysiological point of view and has been documented in literature.…”

Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry

“…ECPR was defined as VA ECMO cannulation during continuous cardiopulmonary resuscitation without return of spontaneous circulation (ROSC); or as VA ECMO cannulation within the first 20 min after ROSC in case of persistent hemodynamic instability as previously suggested [ 25 ]. ECMO cannulation and operation were done according to regularly revised standard operating procedures as described earlier [ 26 , 27 ].…”

“…Blood gas analysis (BGA): BGA were processed as described earlier [ 27 ]. BGA test results were automatically transferred to the electronic patient files.…”

Hyperglycemia and Hypoglycemia Are Associated with In-Hospital Mortality among Patients with Coronavirus Disease 2019 Supported with Extracorporeal Membrane Oxygenation

“…Patients who underwent veno-arterial ECMO for the treatment of cardiogenic shock or cardiac arrest showed the best survival when their blood glucose level at cannulation for ECMO start was 140–240 mg/dL as compared to hypoglycemia (<80 mg/dL), (80–140 mg/dL), moderate hyperglycemia (241–400 mg/dL), and severe hyperglycemia (>400 mg/dL) [ 64 ].…”