Abstract
We investigated whether achieving estimated average glucose (EAG) levels versus achieving standard glucose levels (180 mg/dL) was associated with neurologic outcome in cardiac arrest survivors. This single-center retrospective observational study included adult comatose cardiac arrest survivors undergoing therapeutic hypothermia (TH) from September 2011 to December 2017. EAG level was calculated using HbA1c obtained after the return of spontaneous circulation (ROSC), and the mean glucose level during TH was calculated. We designated patients to the EAG or standard glucose group according to whether the mean blood glucose level was closer to the EAG level or 180 mg/dL. Patients in the EAG and standard groups were propensity score- matched. The primary outcome was the 6-month neurologic outcome. The secondary outcomes were hypoglycemia (≤70 mg/dL) and serum neuron-specific enolase (NSE) at 48 h after ROSC. Of 384 included patients, 137 (35.7%) had a favorable neurologic outcome. The EAG group had a higher favorable neurologic outcome (104/248 versus 33/136), higher incidence of hypoglycemia (46/248 versus 11/136), and lower NSE level. After propensity score matching, both groups had similar favorable neurologic outcomes (24/93 versus 27/93) and NSE levels; the EAG group had a higher incidence of hypoglycemia (21/93 versus 6/93). Achieving EAG levels was associated with hypoglycemia but not neurologic outcome or serum NSE level.
Highlights
Glucose control is an important therapeutic strategy in comatose cardiac arrest survivors [1,2]
EAG, estimated average glucose; ASD, absolute standardized difference; IQR interquartile range; OHCA, out-of-hospital cardiac arrest; CPR, cardiopulmonary resuscitation; return of spontaneous circulation (ROSC), restoration of spontaneous circulation; GCS, Glasgow Coma Scale; SOFA, sequential organ failure assessment; TH therapeutic hypothermia; HbA1c, glycated hemoglobin; PaO2, partial pressure of oxygen; PaCO2, partial pressure of carbon dioxide. *, Number of patients included in the analysis
EAG, estimated average glucose; ASD, absolute standardized difference; IQR interquartile range; NA, not applicable; OHCA, out-of-hospital cardiac arrest; CPR, cardiopulmonary resuscitation; ROSC, restoration of spontaneous circulation; SOFA, sequential organ failure assessment; TH therapeutic hypothermia; HbA1c, glycated hemoglobin; PaO2, partial pressure of oxygen; PaCO2, partial pressure of carbon dioxide. * Number of patients included in the analysis
Summary
Glucose control is an important therapeutic strategy in comatose cardiac arrest survivors [1,2]. A randomized controlled trial proving that conventional glucose control results in lower mortality than strict glucose control in critically ill patients provided a target glucose level of less than 180 mg/dL [7]. Another randomized trial involving ventricular fibrillation out-of-hospital cardiac arrest (OHCA) revealed that there is no difference in mortality between strict (72–108 mg/dL) and moderate (108–144 mg/dL) glucose control [8]. The estimated average glucose (EAG) can be calculated from the HbA1c for practical convenience [12]; one study suggested that the EAG can be a reference value for managing blood glucose levels among in-hospital cardiac arrest survivors with diabetes [13]. We investigated the difference in outcomes between patients achieving standard glucose and EAG levels, using propensity score matching
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