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Hyperglycemia and insulin resistance in cardiac arrest patients treated with moderate hypothermia

Matthew D Ettleson1, Vanessa Arguello, Amisha Wallia

  • 1Division of Endocrinology, Metabolism, and Molecular Medicine (M.D.E., A.W., L.A., M.E.M.), Department of Medicine, and Department of Neurology (R.A.B.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; and Department of Internal Medicine (V.A.), University of Illinois at Chicago/Advocate Christ Medical Center, Chicago, Illinois 60453.

The Journal of Clinical Endocrinology and Metabolism
|July 18, 2014
PubMed

Insights

Hyperglycemia after cardiac arrest, not therapeutic hypothermia (TH), is linked to mortality. Post-arrest blood glucose levels predict survival, suggesting stress from the arrest itself causes elevated glucose.

Area of Science:

  • Critical care medicine
  • Cardiology
  • Endocrinology

Background:

  • Hyperglycemia following cardiac arrest and during therapeutic hypothermia (TH) is common, but its cause and impact on outcomes remain unclear.
  • It is unknown whether hyperglycemia is a direct result of cardiac arrest or TH, or if it influences patient survival.

Purpose of the Study:

  • To investigate the effect of TH on blood glucose (BG) levels in patients post-cardiac arrest.
  • To determine the association between hyperglycemia and mortality in these patients.

Main Methods:

  • A retrospective chart review of 62 patients undergoing TH after cardiac arrest.
  • Analysis of BG levels from 72 hours pre-arrest to 48 hours post-TH, including insulin infusion rates.
  • Correlation of BG levels and insulin resistance with survival to hospital discharge.

Main Results:

  • Therapeutic hypothermia (TH) did not independently affect blood glucose (BG) levels.
  • Nonsurvivors exhibited significantly higher mean BG levels (253 ± 112 mg/dL) compared to survivors (192 ± 69 mg/dL) between cardiac arrest and TH initiation (P = .016).
  • No significant differences in BG, insulin infusion rates, or insulin resistance were observed between groups during or after TH.

Conclusions:

  • Therapeutic hypothermia (TH) does not independently alter blood glucose (BG) levels in post-cardiac arrest patients.
  • Elevated BG levels after cardiac arrest, prior to TH or insulin treatment, are associated with increased mortality.
  • The severity of the cardiac arrest event is likely the primary driver of hyperglycemia in these patients.
Abstract

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