Time to reach target glucose level and outcome after cardiac arrest patients treated with therapeutic hypothermia

• Published in: Journal of critical care Vol. 30; no. 6; pp. 1204 - 1209
• Main Authors: Kim, Soo Hyun, MD, PhD, Park, Kyu Nam, MD, PhD, Choi, Seung Pill, MD, PhD, Kim, Young-Min, MD, PhD, Kim, Han Joon, MD, PhD, Oh, Sang Hoon, MD, Youn, Chun Song, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015; Elsevier Limited
• Subjects: Adult; Aged; Blood Glucose - analysis; Cardiac arrest; Critical Care; Electroencephalography; Female; Glucose; Heart arrest; Heart attacks; Humans; Hyperglycemia; Hyperglycemia - complications; Hyperglycemia - drug therapy; Hyperglycemia - etiology; Hypoglycemic Agents - administration & dosage; Hypothermia induced; Insulin; Insulin - administration & dosage; Male; Middle Aged; Mortality; Multivariate Analysis; Neurologic Examination; Out-of-Hospital Cardiac Arrest - complications; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Patient Discharge; Patient Outcome Assessment; Regression analysis; Retrospective Studies; Survival Analysis; Time Factors; Heart arrest; Hypothermia induced; Hyperglycemia; Insulin; Mortality
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.08.011

Abstract Introduction Hyperglycemia after cardiac arrest is common and associated with unfavorable neurologic outcomes and mortality. This study tested the hypothesis that time to reach target blood glucose level is associated with the outcome of patients after cardiac arrest treated with therapeutic hypothermia (TH). Methods Patients who were treated with TH after cardiac arrest and who had admission blood glucose levels higher than 180 mg/dL were included in this study. The arterial blood glucose target was set at 72 to 180 mg/dL using a written algorithm with a nurse-driven adjustment of the insulin infusion rate. The primary outcomes were patient survival at hospital discharge and favorable neurologic outcomes. Favorable neurologic outcomes were defined as Cerebral Performance Category scores of 1 and 2. Multivariate logistic regression analysis was performed with variables with various significance levels in univariate analysis. Results One hundred three patients were included in this study. Patients were categorized into 3 groups. The mean patient age was 53 years, and 58% of the patients were male. Eighteen patients had a history of diabetes. Seventy-two patients (70%) survived, and 41 (40%) achieved favorable neurologic outcomes at the hospital discharge. Multivariate logistic analysis showed that early target achievement of blood glucose level within 4 hours was significantly associated with survival at hospital discharge and favorable neurologic outcomes. Conclusions The time to reach target glucose level was significantly associated with survival and favorable neurologic outcomes at hospital discharge in patients treated with TH after cardiac arrest.