Association between Intra-Arrest Blood Glucose Level and Outcomes of Resuscitation at the Emergency Department: A Retrospective Study

Abstract

Since current cardiac arrest guidelines do not address the benefit of blood glucose measurement, the ideal ranges and target of blood glucose (BG) levels during cardiac arrest to achieve a better result are warranted. We intended to investigate the associations between intra-arrest BG levels and outcomes of cardiac arrest resuscitation at the emergency department (ED). We conducted a retrospective observational study at a single university hospital. Cardiac arrest patients at the ED between 2017 and 2020 were included. Multivariable logistic regression analysis was performed to examine the associations between intra-arrest BG levels and clinical outcomes. We categorized intra-arrest BG into five groups: <70 mg/dL, 70–99 mg/dL, 100–180 mg/dL, 181–250 mg/dL, and >250 mg/dL. Eight hundred and nineteen patients experienced ED cardiac arrest during the study period. Of all, 385 intra-arrest BG measurements were included in the data analysis. The mean age was 60.4 years. The mean intra-arrest BG level was 171.1 mg/dL, with 64 (16.6%) patients who had intra-arrest BG level below 70 mg/dL and 73 (19.0%) patients who had intra-arrest BG level more than 250 mg/dL. Markedly low (<70 mg/dL) and low (70–99 mg/dL) intra-arrest BG levels were significantly associated with a lower chance of return of spontaneous circulation (ROSC, OR 0.36, 95% CI 0.14–0.99, p = 0.05 and OR 0.33, 95% CI 0.12–0.93, p = 0.04, respectively). For patients who experienced cardiac arrest at the ED, an intra-arrest BG level of less than 100 was inversely correlated with sustained ROSC. Although we could not draw a causal relationship between variables concerning this study design, normalizing intra-arrest BG was shown to result in good clinical outcomes.

Dextrose Administration and Resuscitation Outcomes in Patients with Blood Sugar Less Than 150 mg/dL during Cardiopulmonary Resuscitation: An Observational Data Analysis

“…Overall, our current study contributes to the growing body of literature regarding the association between dextrose administration during CPR and resuscitation outcomes. Although earlier studies documented that a low intra-arrest blood glucose level was strongly correlated with poor outcomes [ 8 , 9 ], this study highlights that dextrose might not provide a significant additional benefit or harmful effect. The correction of hypoglycemia during cardiac arrest might not result in a better outcome, questioning the importance of dextrose administration during CPR.…”

“…Expected dextrose delivery in cardiac arrest is not advised since it is linked with increased neurologic morbidity and a worse likelihood of survival to hospital discharge [ 20 ]. Nonetheless, our previous study found that intra-arrest blood glucose levels less than 100 mg/dL were associated with a lower chance of sustained ROSC [ 9 ]. However, according to this study, administering dextrose might not increase the chance of ROSC.…”

“…In this study, low blood glucose was defined as a level below 150 mg/dL based on the findings of a previous study by Wang et al, which showed that CA patients with blood glucose levels below 150 mg/dL had poor neurological recovery [ 8 ]. Earlier evidence demonstrated that a hypoglycemic state during CA is associated with poor outcomes [ 8 , 9 ]. A recent case report, on the other hand, documented a rapid restoration of spontaneous circulation following dextrose treatment for hypoglycemia (10.8 mg/dL) [ 10 ].…”

“…Furthermore, a preclinical study illustrated that fatal ventricular arrhythmias occurred during severe hypoglycemia and could be diminished by intravenous dextrose infusion and prevented by the β-adrenergic blockade, suggesting that brain neuroglycopenia and the stimulating sympathoadrenal response mediated fatal cardiac arrhythmias during severe hypoglycemia [ 11 ]. However, a study by Wang et al showed that the administration of dextrose during CPR was not associated with better outcomes, including survival to hospital discharge and good neurological status at discharge [ 9 ]. Currently, the recommendation for treating hypoglycemia during CA is still controversial.…”

How effective is extracorporeal life support for patients with out-of-hospital cardiac arrest initiated at the emergency department? A systematic review and meta-analysis

“…Approximately 350,000 individuals die from out-of-hospital cardiac arrest (OHCA) in the United States [1]. Despite significant advances in treatments such as rapid reperfusion, aggressive post-resuscitation care, and targeted temperature management (TTM), the rates of neurologically intact survival to hospital discharge remain alarmingly low, ranging from 6% to 9% [2][3][4][5].…”