Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12 h after cardiac arrest might not be necessary

SummaryAim of the studyThe admission blood glucose level after cardiac arrest is predictive of outcome. However the blood glucose levels in the post-resuscitation period, that are optimal remains a matter of debate. We wanted to assess an association between blood glucose levels at 12 h after restoration of spontaneous circulation and neurological recovery over 6 months.Materials and methodsA total of 234 patients from a multi-centre trial examining the effect of mild hypothermia on neurological outcome were included. According to the serum glucose level at 12 h after restoration of spontaneous circulation, quartiles (Q) were generated: Median (range) glucose concentrations were for QI 100 (67–115 mg/dl), QII 130 (116–143 mg/dl), QIII 162 (144–193 mg/dl) and QIV 265 (194–464 mg/dl).ResultsIn univariate analysis there was a strong non-linear association between blood glucose and good neurological outcome (odds ratio compared to QIV): QI 8.05 (3.03–21.4), QII 13.41 (4.9–36.67), QIII 1.88 (0.67–5.26). After adjustment for sex, age, “no-flow” and “low-flow” time, adrenaline (epinephrine) dose, history of coronary artery disease and myocardial infarction, and therapeutic hypothermia, this association still remained strong: QI 4.55 (1.28–16.12), QII 13.02 (3.29–49.9), QIII 1.37 (0.38–5.64).ConclusionThere is a strong non-linear association of survival with good neurological outcome and blood glucose levels 12 h after cardiac arrest even after adjusting for potential confounders. Not only strict normoglycaemia, but also blood glucose levels from 116 to 143 mg/dl were correlated with survival and good neurological outcome, which might have an important therapeutic implication.