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Higher Prehospital Blood Glucose Levels Associated With Return of Spontaneous Circulation in Out-of-Hospital
Ayman Shehadeh1, Jeffrey Feng1, William Selde2
1Department of Student Affairs, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI.
Insights
Prehospital blood glucose levels significantly impact survival after cardiac arrest. Hypoglycemia was associated with a 77% lower chance of return of spontaneous circulation (ROSC) in non-traumatic out-of-hospital cardiac arrests (OHCAs).
Area of Science:
- Emergency Medicine
- Critical Care
- Metabolic Disorders
Background:
- Cardiac arrest triggers metabolic disturbances.
- Prehospital blood glucose levels (BGLs) are a key metabolic indicator.
- Understanding BGLs' impact on resuscitation outcomes is crucial.
Purpose of the Study:
- To investigate the association between prehospital BGLs and return of spontaneous circulation (ROSC).
- To analyze BGLs in non-traumatic out-of-hospital cardiac arrests (OHCAs).
Main Methods:
- Retrospective analysis of 314 adult non-traumatic OHCAs (Jan 2018-May 2020).
- Data abstracted from the Michigan EMS Information System database.
- BGLs categorized as hypoglycemia (<70 mg/dL), euglycemia (70-120 mg/dL), and hyperglycemia (>120 mg/dL).
- Chi-square and Wilcoxon rank sum tests used for statistical analysis.
Main Results:
- ROSC was achieved in 46.8% of patients.
- Hypoglycemia (15.9%), euglycemia (23.9%), and hyperglycemia (60.2%) were observed.
- A significant association (P < .0001) was found between BGL group and ROSC.
- Hypoglycemic patients had 77% lower odds of ROSC compared to euglycemic or hyperglycemic patients.
- Patients achieving ROSC had significantly higher median prehospital BGLs (160 mg/dL) than those without ROSC (127 mg/dL).
Conclusions:
- Higher prehospital BGLs are associated with successful ROSC in non-traumatic OHCAs.
- Intra-arrest BGL may serve as a prognostic marker for ROSC.
- Further research is warranted to explore the role of BGL in cardiac arrest outcomes.
Objective:
Cardiac arrest leads to an array of metabolic disturbances. We aimed to investigate the association between prehospital blood glucose levels (BGLs) and rates of return of spontaneous circulation (ROSC) in non-traumatic out-of-hospital cardiac arrests (OHCAs).
Methods:
A retrospective analysis of adult non-traumatic OHCAs within Kalamazoo County, MI, from January 2018 to May 2020 using the Michigan Emergency Medical Services Information System database was performed. Demographic data, Utstein variables, and BGLs (hypoglycemia < 70 mg/dL, euglycemia 70-120 mg/dL, and hyperglycemia >120 mg/dL) were abstracted. Chi-square and Wilcoxon rank sum tests were used to evaluate the relationship between BGL and ROSC.
Results:
In total, 314 patients met the inclusion criteria. The mean age was 62.9 years. ROSC was achieved in 147 (46.8%) patients. Fifty (15.9%), 75 (23.9%), and 189 (60.2%) patients were hypoglycemic, euglycemic, and hyperglycemic, respectively. An association was found between the glycemic group and ROSC (P < .0001), with an estimated odds of ROSC being 77% lower (95% confidence interval, 46%-90%) for hypoglycemic than euglycemic or hyperglycemic patients. The point difference between median ROSC-yes BGL (median [interquartile range] = 160 mg/dL [110-225 mg/dL]) was 33 mg/dL (95% CI, 13-51 mg/dL) greater than the ROSC-no group (median [interquartile range] = 127 mg/dL [75-190 mg/dL], P = .001).
Conclusion:
Non-traumatic OHCA patients achieving ROSC had a significantly higher prehospital BGL than the ROSC-no group. Further study is warranted to investigate the role intra-arrest BGL may have as a prognostic marker for ROSC.
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