Elevated prehospital point-of-care glucose is associated with worse neurologic outcome after out-of-hospital cardiac arrest

• Published in: Resuscitation plus Vol. 9; p. 100204
• Main Authors: Abramson, Tiffany M., Bosson, Nichole, Whitfield, Denise, Gausche-Hill, Marianne, Niemann, James T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2022; Elsevier
• Subjects: Emergency medical services; Glucose; Heart arrest; Hyperglycemia; Neurologic outcome; Prehospital; Short Paper; POC; EMS; Glucose; ROSC; TTM; Prehospital; SHD; Neurologic outcome; LAC; Heart arrest; Hyperglycemia; OHCA; CPC; PCI; Emergency medical services; TTM, Targeted temperature management; CPC, Cerebral performance category; POC, Point-of-care; LAC, Los Angeles County; OHCA, Out-of-hospital cardiac arrest; PCI, Percutaneous coronary intervention; ROSC, Return of spontaneous circulation; SHD, Survival to hospital discharge (SHD); EMS, Emergency medical services
• DOI: 10.1016/j.resplu.2022.100204
• ISSN: 2666-5204

Hyperglycemia is associated with poor outcomes in critically-ill patients. This has implications for prognostication of patients with out-of-hospital cardiac arrest (OHCA) and for post-resuscitation care. We assessed the association of hyperglycemia, on field point-of-care (POC) testing, with survival and neurologic outcome in patients with return of spontaneous circulation (ROSC) after OHCA. This was a retrospective analysis of data in a regional cardiac care system from April 2011 through December 2017 of adult patients with OHCA and ROSC who had a field POC glucose. Patients were excluded if they were hypoglycemic (glucose <60 mg/dl) or received empiric dextrose. We compared hyperglycemic (glucose >250 mg/dL) with euglycemic (glucose 60–250 mg/dL) patients. Primary outcome was survival to hospital discharge (SHD). Secondary outcome was survival with good neurologic outcome (cerebral performance category 1 or 2 at discharge). We determined the adjusted odds ratios (AORs) for SHD and survival with good neurologic outcome. Of 9008 patients with OHCA and ROSC, 6995 patients were included; 1941 (28%) were hyperglycemic and 5054 (72%) were euglycemic. Hyperglycemic patients were more likely to be female, of non-White race, and have an initial non-shockable rhythm compared to euglycemic patients (p < 0.0001 for all). Hyperglycemic patients were less likely to have SHD compared to euglycemic survivors, 24.4% vs 32.9%, risk difference (RD) −8.5% (95 %CI −10.8%, −6.2%), p < 0.0001. Hyperglycemic survivors were also less likely to have good neurologic outcome compared to euglycemic survivors, 57.0% vs 64.6%, RD −7.6% (95 %CI −12.9%, −2.4%), p = 0.004. The AOR for SHD was 0.72 (95 %CI 0.62, 0.85), p < 0.0001 and for good neurologic outcome, 0.70 (95 %CI 0.57, 0.86), p = 0.0005. In patients with OHCA, hyperglycemia on field POC glucose was associated with lower survival and worse neurologic outcome.