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Intensive Care Medicine

, Volume 33, Issue 12, pp 2093–2100 | Cite as

Strict versus moderate glucose control after resuscitation from ventricular fibrillation

  • Tuomas OksanenEmail author
  • Markus B. Skrifvars
  • Tero Varpula
  • Anne Kuitunen
  • Ville Pettilä
  • Jouni Nurmi
  • Maaret Castrén
Original

Abstract

Objective

Elevated blood glucose is associated with poor outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Our aim was to determine whether strict glucose control with intensive insulin treatment improves outcome of OHCA patients.

Design

A randomized, controlled trial.

Setting

Two university hospital intensive care units.

Patients

Ninety patients resuscitated from OHCA with ventricular fibrillation detected as the initial rhythm were treated with therapeutic hypothermia.

Interventions

Patients were randomized into two treatment groups: a strict glucose control group (SGC group), with a blood glucose target of 4–6 mmol/l, or a moderate glucose control group (MGC group), with a blood glucose target of 6–8 mmol/l. Both groups were treated with insulin infusion for 48 h, because a control group with no treatment was considered unethical.

Measurements and results

Baseline data were similar in both groups. In the SGC group 71% of the glucose measurements were within the target range compared with 41% in the MGC group. Median glucose was 5.0 mmol/l in the SGC group and 6.4 mmol/l in the MGC group. The occurrence of moderate hypoglycemic episodes was 18% in the SGC group and 2% in the MGC group (p = 0.008). No episodes of severe hypoglycemia occurred. Mortality by day 30 was 33% in the SGC group and 35% in the MGC group (p = 0.846); the difference was 2% (95% CI –18% to +22%).

Conclusions

We found no additional survival benefit from strict glucose control compared with moderate glucose control with a target between 6 and 8 mmol/l in OHCA patients.

Keywords

Randomized controlled trial Resuscitation Glucose Hypothermia Mortality Enolase 

Notes

Acknowledgements

We would like to thank for funding the Laerdal Foundation and the Instrumentarium Foundation, and for data collection the medical student Erkko Klemetti, and the study nurses Pia Simon, Nina Nakari, Leena Pettilä, Kirsi Ruohomäki, and Teemu Hult and the ICU personnel in the Jorvi and Meilahti hospitals.

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Tuomas Oksanen
    • 1
    Email author
  • Markus B. Skrifvars
    • 2
  • Tero Varpula
    • 1
  • Anne Kuitunen
    • 2
  • Ville Pettilä
    • 2
  • Jouni Nurmi
    • 2
  • Maaret Castrén
    • 3
  1. 1.Intensive Care Units, Jorvi HospitalHelsinki University HospitalEspooFinland
  2. 2.Intensive Care Units, Department of Anaesthesiology and Intensive Care MedicineHelsinki University HospitalHelsinkiFinland
  3. 3.Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden

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