Influence of Intra-Arrest Glucose on Patient Outcomes in Out-of-Hospital Cardiac Arrest

Cardiac arrest leads to an array of metabolic disturbances, including glucose metabolism. Intra-arrest blood glucose level (BGL) is rarely reported in out-of-hospital cardiac arrest (OHCA) literature, and the influence of BGL on patient outcomes has yet to be conclusively established. To describe the interrelationship between intra-arrest BGL, dextrose administration, and short-term outcomes.

A retrospective analysis of the 2020 ESO Data Collaborative Annual Research dataset was conducted that included adults who experienced non-traumatic arrests prior to emergency medical services (EMS) arrival and for whom at least one intra-arrest BGL was measured. Logistic regression was used to determine the association between BGL and return of spontaneous circulation (ROSC) while controlling for confounding variables. In this analysis, BGL was modeled with seven categories representing visually distinct bins of the unadjusted probability distribution of ROSC stratified by first intra-arrest glucose measurement.

Data were available for 16,847 patients, of which presumed cardiac etiology was present in 81.6%, followed by respiratory/asphyxia (9.6%), drug overdose (5.0%), and other (3.7%). Most (62.0%) were males with a mean age of 63.5 (±16.7) years and a mean BGL of 184.4 (±104.8) mg/dL. Present in 20.0% was an initial shockable rhythm, while 25.8% received bystander cardiopulmonary resuscitation, and 35.9% attained ROSC. Compared to patients with BGLs of 161-300 mg/dL, patients with ≤50 mg/dL, 51-110 mg/dL, 111-160 mg/dL, 351-430 mg/dL, and ≥431mg/dL were less likely to attain ROSC (OR = 0.407, 0.543, 0.864, 0.718, 0.574, respectively, all p < 0.001). There was no association between ROSC and BGLs of 301-350 mg/dL compared to the reference category (OR = 0.862, p = 0.059). For cumulative BGL ≤ 90 mg/dL, no statistically significant difference in the odds of ROSC between those who received dextrose and those who did not was observed. For cumulative BGL values above 90 mg/dL, intra-arrest dextrose administration was associated with a lower odds of ROSC.

Within the limitations of our observational study design, these data suggest that an association exists between the likelihood of ROSC and intra-arrest BGL. However, this relationship does not appear to be improved with exogenous dextrose administration at any threshold of intra-arrest BGL. Additional study using more robust designs is warranted to further elucidate the interrelationship between BGL, dextrose administration, and longer-term patient outcomes.