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

Abstract

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.

Post–Cardiac Arrest Syndrome

“…10,[65][66][67][68][69][70] Animal studies suggest that elevated postischemic blood glucose concentrations exacerbate ischemic brain injury, 71,72 and this effect can be mitigated by intravenous insulin therapy. 73,74 Seizures in the post-cardiac arrest period are associated with worse prognosis and are likely to be caused by, as well as exacerbate, post-cardiac arrest brain injury.…”

Rapid implementation of therapeutic hypothermia in comatose out‐of‐hospital cardiac arrest survivors

“…No difference in arrhythmias was noted in the two groups. Cooling also leads to hyperglycaemia (8,13), which in itself has been linked to bad outcome (23,38,39). Most authors now agree that insulin infusion to secure normoglycaemia should be a standard part of neurointensive care (8,13,15,26,27,29,32).…”

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

“…Non-intervention studies have shown increased mortality among cardiac arrest patients with high levels of blood glucose 60,67,68 (GOE IV-V). Aggressive insulin treatment in patients with critical illness has reduced long-time mortality 69 (GOE I). Thus, hyperglycaemia should be avoided and treated with insulin infusions (GOR B).…”