Blood glucose and neurologic outcome with global brain ischemia.
OBJECTIVE
To investigate the relationship between neurologic outcome and blood glucose concentrations in survivors of cardiopulmonary arrest.


METHODS
Retrospective case series chart review.


METHODS
Adult multidisciplinary intensive care unit (ICU) of a tertiary referral medical center.


METHODS
Consecutive patients over a 12-month period surviving cardiopulmonary resuscitation (CPR).


METHODS
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.


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.
Steingrub
J S
JS
Department of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
Mundt
D J
DJ
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D015600:Glasgow Coma Scale; D006801:Humans; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D001786:Blood Glucose