Abstract 187: Diabetes is Associated With Mortality Among Comatose Survivors of Cardiac Arrest but Does Not Interact With Blood-Pressure Targets

Abstract

Introduction: The prevalence of diabetes (DM) is increasing and associated with cardiovascular morbidity and mortality. Whether patients with DM may benefit from other treatment targets after cardiac arrest remain sparsely described. Aim: This study aimed to assess blood-pressure targets among patients with and without DM successfully resuscitated from out-of-hospital cardiac arrest (OHCA). Methods: In a large double-blind RCT, a mean arterial blood-pressure (MAP) of 63 mmHg (Low) vs 77 mmHg (High) was targeted among OHCA patients with a presumed cardiac cause. Patients were stratified according to DM and the primary endpoint was all-cause 365-day mortality. In addition, a Cox regression model with DM and treatment allocation interaction was used and adjustment for age and sex was additionally performed. Results: A total of 789 patients were included of which 110 (14 %) had DM. The DM patients were older (median 67 vs 63 years) and had more comorbidities including hypertension (75 vs 41 %) and ischemic heart disease (31 vs 20 %) p<0.05 for all. The DM and non-DM patients showed similar characteristics with regards to prehospital management including bystander CPR (87 vs 88 %), time to advanced life support (median 7 vs 7 min), shockable rhythm (87 vs 90 %) and time to ROSC (median 19 vs 18 min), p NS for all. Upon hospital arrival the DM patients presented with higher lactate (median 6.7 vs 4.6 mmol/L p<0.001) and higher blood glucose (median 17.4 vs 12.8 mmol/L p<0.001). An increased 365-day mortality was observed among DM patients, Figure. Adjusted p=0,07. In the Cox model no modifying effect of the MAP targets was observed (p DM x MAP =0.24). Hazard ratio CI 95 % High vs Low for DM 0.81 [0.46;1.44], p= 0.48 and non DM 1.18 [0.91;1.53], p= 0.21. Upon adjustment (p DM x MAP =0.27). Conclusion: Diabetes was associated with mortality among OHCA patients which was partly driven by age. No difference was however observed whether a MAP of 63 mmHg or 77 mmHg was targeted.