Association between Blood Glucose and cardiac Rhythms during pre-hospital care of Trauma Patients – a retrospective Analysis

Abstract

BackgroundDeranged glucose metabolism is frequently observed in trauma patients after moderate to severe traumatic injury, but little data is available about pre-hospital blood glucose and its association with various cardiac rhythms and cardiac arrest following trauma.MethodsWe retrospectively investigated adult trauma patients treated by a nationwide helicopter emergency medical service (34 bases) between 2005 and 2013. All patients with recorded initial cardiac rhythms and blood glucose levels were enrolled. Blood glucose concentrations were categorised; descriptive and regression analyses were performed.ResultsIn total, 18,879 patients were included, of whom 185 (1.0%) patients died on scene. Patients with tachycardia (≥100/min, 7.0 ± 2.4 mmol/L p < 0.0001), pulseless ventricular tachycardia (9.8 ± 1.8, mmol/L, p = 0.008) and those with ventricular fibrillation (9.0 ± 3.2 mmol/L, p < 0.0001) had significantly higher blood glucose concentrations than did patients with normal sinus rhythm between 61 and 99/min (6.7 ± 2.1 mmol/L). In patients with low (≤2.8 mmol/L, 7/79; 8.9%, p < 0.0001) and high (> 10.0 mmol/L, 70/1271; 5.5%, p < 0.0001) blood glucose concentrations cardiac arrest was more common than in normoglycaemic patients (166/9433, 1.8%). ROSC was more frequently achieved in hyperglycaemic (> 10 mmol/L; 47/69; 68.1%) than in hypoglycaemic (≤4.2 mmol/L; 13/31; 41.9%) trauma patients (p = 0.01).ConclusionsIn adult trauma patients, pre-hospital higher blood glucose levels were related to tachycardic and shockable rhythms. Cardiac arrest was more frequently observed in hypoglycaemic and hyperglycaemic pre-hospital trauma patients. The rate of ROSC rose significantly with rising blood glucose concentration. Blood glucose measurements in addition to common vital parameters (GCS, heart rate, blood pressure, breathing frequency) may help identify patients at risk for cardiopulmonary arrest and dysrhythmias.

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

“…In contrast, the threshold of 250 mg/dL (13.88 mmol/L) is one of the diagnostic criteria for diabetic ketoacidosis, a life-threatening complication of hyperglycemia [ 18 ]. However, prior studies on the effects of hypoglycemia on cardiac arrests used a wide range of cut-off values ranging from 100–150 mg/dL [ 6 , 9 , 14 , 19 ]. According to the American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) task force on inpatient glycemic control [ 20 ], a glucose level between 140 and 180 mg/dL has been recommended for the ICU patients [ 21 ].…”

“…Moreover, the benefit of intra-arrest BG normalization during CPR is not well-documented. As a result, this study aims to investigate a relationship between BG level and resuscitation outcomes, including the probability of ROSC, survival to hospital admission, survival to hospital discharge, and favorable neurological outcome at hospital discharge [ 14 , 15 ].…”

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

“…Over the last two decades, a vast number of publications have demonstrated the fundamental role of stress hyperglycemia in critical injury [1][2][3][4] and diverse critical conditions [21][22][23][24]. Up to date, there has been no consistency in de ning blood glucose levels, wherefore this trial resigns from specifying any threshold values for stress hyperglycemia.…”

“…Stress hyperglycemia is common in trauma patients and critical illness upon hospital admission and is often associated with worse outcome [1][2][3][4]. Hemorrhage aggravates this stress hyperglycemia signi cantly [5,6].…”

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

“…Stress hyperglycemia is common in trauma patients, and critical illness on hospital admission and is often associated with poor outcome [1][2][3][4][5][6][7]. This stress hyperglycemia is caused by neuroendocrine, inflammatory and metabolic responses to trauma-associated stressors.…”