Hypoglycemic cardiac arrest and rapid return-of-spontaneous circulation (ROSC) with dextrose

Fun, Joan Rui Shan; Chia, Michael Yih Chong

doi:10.1016/j.ajem.2020.05.025

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…Interestingly, interventions to normalize intra-arrest BG levels are still debatable. Despite showing in a case report [ 8 ] that the administration of dextrose during hypoglycemic cardiac arrest resulted in a rapid ROSC, Wang et al reported that dextrose administration was not correlated with improved outcomes of in-hospital cardiac arrest patients with intra-arrest BG <150 mg/dL [ 9 ]. On the other hand, hyperglycemia is also common during CPR [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, measuring BG and acute management of hypoglycemia during CPR was not discussed in a subsequent edition [ 7 ]. On the other hand, a previous case report documented a sudden return of spontaneous circulation (ROSC) after administration of dextrose for hypoglycemia (10.8 mg/dL) [ 8 ]. However, a study by Wang and colleagues demonstrated that dextrose administration did not pose any benefits, including survival to hospital discharge and favorable neurological outcomes, during cardiac arrest [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, a study by Wang and colleagues demonstrated that dextrose administration did not pose any benefits, including survival to hospital discharge and favorable neurological outcomes, during cardiac arrest [ 9 ]. Unlike hypoglycemia, hyperglycemia during cardiac arrest was not well established to be related to a higher chance of return of spontaneous circulation (ROSC) or neurological outcomes [ 8 ]. Apart from the intra-arrest phase, the BG level also plays a powerful role in post-resuscitation care [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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

Wongtanasarasin

Ungrungseesopon

Phinyo

2022

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Wongtanasarasin

Ungrungseesopon

Phinyo

2022

JCM

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“…This case reminds the clinician to consider hypoglycemia in patients with sudden cardiac arrest and to attempt correcting low blood glucose if noted. However, random administration of glucose is not advisable as it carries poor neurologic outcomes [21].…”

Section: Discussionmentioning

confidence: 99%

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

Tilahun

Gudina

2021

J Med Case Reports

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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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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Wongtanasarasin

Phinyo

2023

JCM

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Low blood sugar is commonly found during cardiopulmonary resuscitation (CPR). However, current guidelines do not mention the importance of glucose testing and acute management for hypoglycemia during CPR. We intended to investigate the association between dextrose administration and resuscitation outcomes in patients with blood sugar less than 150 mg/dL during cardiac arrest in the emergency department (ED). We conducted a retrospective cohort study at a tertiary hospital between 2017 and 2020, including patients with intra-arrest blood glucose <150 mg/dL. Logistic regression with inverse probability treatment weighting (IPTW) was used. The primary outcome was the return of spontaneous circulation (ROSC). Secondary outcomes included survival to hospital admission and hospital discharge and favorable neurological outcomes at discharge. A total of 865 patients received CPR at the ED during the study period. Of these, 229 with low blood sugar were included (60 in the treatment group and 169 in the non-treatment group). The mean age was 59.5 ± 21.4 years. After IPTW, dextrose administration during CPR was not associated with ROSC (adjusted OR [aOR] 1.44, 95% CI 0.30–0.69), survival to hospital admission (aOR 1.27, 95% CI 0.54–3.00), survival to hospital discharge (aOR 0.68, 95% CI 0.20–2.29), and favorable neurological status (aOR 2.21, 95% CI 0.23–21.42). Our findings suggested that dextrose administration during CPR at the ED might not lead to better or worse resuscitation outcomes. Owing to the design limitations and residual confounding factors, strong recommendations for dextrose administration could not be formulated. Further evidence is needed from prospective trials to confirm the efficacy of dextrose during CPR.

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Hypoglycemic cardiac arrest and rapid return-of-spontaneous circulation (ROSC) with dextrose

Cited by 6 publications

References 10 publications

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

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

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

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

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