Abstract
IntroductionDextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. However, the incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown.MethodsWe used the Get With The Guidelines®-Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between the years 2000 and 2010. To assess the adjusted effects of dextrose administration on survival, we used multivariable regression models with adjustment for multiple patient, event, and hospital characteristics. We performed additional analyses to examine the effects of dextrose on neurological outcome and return of spontaneous circulation.ResultsAmong the 100,029 patients included in our study, 4,189 (4.2%) received dextrose during cardiac arrest resuscitation. The rate of dextrose administration increased during the study period (odds ratio 1.11, 95% confidence interval (CI) 1.09-1.12 per year, P <0.001). Patients who received dextrose during resuscitation had lower rates of survival compared with patients who did not receive dextrose (relative risk 0.88, 95% CI 0.80-0.98, P = 0.02). Administration of dextrose was associated with worse neurological outcome (relative risk 0.88, 95% CI 0.79-0.99, P = 0.03) but an increased chance of return of spontaneous circulation (relative risk 1.07, 95% CI 1.04-1.10, P <0.001).ConclusionsIn this dataset, the administration of dextrose during resuscitation in patients with in-hospital cardiac arrest was found to be associated with a significantly decreased chance of survival and a decreased chance of good neurological outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0867-z) contains supplementary material, which is available to authorized users.
Highlights
Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia
There was a significant increase in the incidence of dextrose administration from 2000 (2.5%) to 2010 (5.7%) (Figure 2)
Patients who received dextrose during cardiac arrest resuscitation had a lower rate of survival to discharge compared with patients who did not receive dextrose (RR 0.49, 95% confidence interval (CI) 0.44-0.54, P
Summary
Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. The incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown. In-hospital cardiac arrest (IHCA) is one of the leading causes of death in the United States, with an incidence of over 200,000 patients per year and a mortality rate of more than 75% [1]. In 2005, the American Heart Association guidelines for advanced cardiac life support (ACLS) [5] listed hypoglycemia as a reversible cause of cardiac arrest but removed it upon the publication of the current 2010 ACLS guidelines [6]. Pre-2005 editions of the ACLS guidelines have never included hypoglycemia as a reversible cause of cardiac arrest, and the provision of dextrose during cardiac arrest in the absence of confirmed hypoglycemia is not suggested in the current guidelines [7]. The current 2010 ACLS guidelines recommend the use of dextrose with insulin to treat severe hyperkalemia and suggest that insulin with dextrose can be considered for
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