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Blood glucose and neurologic outcome with global brain ischemia
1Department of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
Objective:
To investigate the relationship between neurologic outcome and blood glucose concentrations in survivors of cardiopulmonary arrest.
Design:
Retrospective case series chart review.
Setting:
Adult multidisciplinary intensive care unit (ICU) of a tertiary referral medical center.
Subjects:
Consecutive patients over a 12-month period surviving cardiopulmonary resuscitation (CPR).
Interventions:
Variables that were examined that could affect the relationship between the circulating glucose concentration and neurologic outcome included: location of arrest (inhospital/out-of-hospital), age, history of diabetes mellitus, duration of arrest, CPR duration, initial cardiac rhythm, and drugs administered during arrest. Cerebral recovery was evaluated by a 5-point outcome scale (Glasgow Pittsburgh Brain Stem Score) on ICU admission, and 24 and 48 hrs after ICU admission.
Measurements And Main Results:
Observations were made on 85 patients, of whom 67% had inpatient CPR and 33% received out-of-hospital CPR. The duration of arrest of 66 (78%) patients was <5 mins. Mean CPR duration was 13.7 mins. Twenty-one percent of patients had diabetes. The mean blood glucose concentration post-CPR (n = 80) was 272 mg/dL (15.1 mmol/L). A statistically significant association was shown between high glucose concentration post-CPR and severe cerebral outcome among a small subset of patients with CPR lasting >5 min.
Conclusions:
The present study does not support an association between the concentration of glucose post-CPR and neurologic outcome. The previously reported casual relationship between hyperglycemia and neurologic prognosis may be an epiphenomenon of the severity of global cerebral ischemia in humans.