Intensive Care Medicine

, Volume 40, Issue 6, pp 855–862

Blood glucose level and outcome after cardiac arrest: insights from a large registry in the hypothermia era

  • Fabrice Daviaud
  • Florence Dumas
  • Nadège Demars
  • Guillaume Geri
  • Adrien Bouglé
  • Tristan Morichau-Beauchant
  • Yên-Lan Nguyen
  • Wulfran Bougouin
  • Frédéric Pène
  • Julien Charpentier
  • Alain Cariou
Original

DOI: 10.1007/s00134-014-3269-9

Cite this article as:
Daviaud, F., Dumas, F., Demars, N. et al. Intensive Care Med (2014) 40: 855. doi:10.1007/s00134-014-3269-9

Abstract

Introduction

The influence of blood glucose (BG) level during the post-resuscitation period after out-of-hospital cardiac arrest (OHCA) is still debated. To evaluate the relationship between blood glucose level and outcome, we included the median glycemia and its maximal amplitude over the first 48 h following ICU admission in an analysis of outcome predictors.

Methods

We conducted a database study in a cardiac arrest center in Paris, France. Between 2006 and 2010, we included 381 patients who were all resuscitated from an OHCA. A moderate glycemic control was applied in all patients. The median glycemia and the largest change over the first 48 h were included in a multivariate analysis that was performed to determine parameters associated with a favorable outcome.

Results

Of the 381 patients, 136 (36 %) had a favorable outcome (CPC 1–2). Median BG level was 7.6 mmol/L (6.3–9.8) in patients with a favorable outcome compared to 9.0 mmol/L (IQR 7.1–10.6) for patients with an unfavorable outcome (p < 0.01). Median BG level variation was 7.1 (4.2–11) and 9.6 (5.9–13.6) mmol/L in patients with and without a favorable outcome, respectively (p < 0.01). In multivariate analysis, an increased median BG level over the first 48 h was found to be an independent predictor of poor issue [OR = 0.43; 95 % CI (0.24–0.78), p = 0.006]. Finally a progressive increase in median BG level was associated with a progressive increase in the proportion of patients with a poor outcome.

Conclusion

We observed a relationship between high blood glucose level and outcome after cardiac arrest. These results suggest the need to test a strategy combining both control of glycemia and minimization of glycemic variations for its ability to improve post-resuscitation care.

Keywords

Cardiac arrestNeurologic outcomeBlood glucoseGlycemic variationsCaloric inputInsulin intake

Supplementary material

134_2014_3269_MOESM1_ESM.docx (343 kb)
Supplementary material Fig. 1: decision algorithm for post-CA patients (DOCX 343 kb)
134_2014_3269_MOESM2_ESM.doc (32 kb)
Supplementary material Table 1: insulin administration protocol. Outcome assessment and life support treatment withdrawal (DOC 31 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Fabrice Daviaud
    • 1
    • 3
  • Florence Dumas
    • 2
    • 3
    • 4
  • Nadège Demars
    • 1
  • Guillaume Geri
    • 1
    • 3
  • Adrien Bouglé
    • 1
    • 3
  • Tristan Morichau-Beauchant
    • 1
    • 3
  • Yên-Lan Nguyen
    • 1
    • 3
  • Wulfran Bougouin
    • 1
    • 3
  • Frédéric Pène
    • 1
    • 3
  • Julien Charpentier
    • 1
    • 3
  • Alain Cariou
    • 1
    • 3
    • 4
  1. 1.Medical Intensive Care UnitCochin University Hospital, Assistance Publique-Hôpitaux de ParisParisFrance
  2. 2.Emergency DepartmentCochin University Hospital, Assistance Publique-Hôpitaux de ParisParisFrance
  3. 3.Paris Descartes UniversityParisFrance
  4. 4.INSERM U970 (Team 4)ParisFrance