Blood glucose and neurologic outcome with global brain ischemia

Author(s): Mundt, D. J.

Journal/Book: Crit Care Med. 1996; 24: 351 West Camden St, Baltimore, MD 21201-2436. Williams & Wilkins. 802-806.

Abstract: 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 mins. Conclusions: The present study does not support an association between the concentration of glucose post CPR and neuro logic outcome, The previously reported causal relationship between hyperglycemia and neurologic prognosis may be an epiphenomenon of the severity of global cerebral ischemia in humans.

Note: Article JS Steingrub, Baystate Med Ctr, Div Crit Care, Dept Med, 759 Chestnut St, Springfield, MA 01199 USA

Keyword(s): cardiopulmonary resuscitation; glucose; lactic acid; ischemia, brain; neurologic emergencies; critical illness; HOSPITAL CARDIOPULMONARY RESUSCITATION; EXPERIMENTAL CEREBRAL-ISCHEMIA; CARDIAC-ARREST; CELL-DAMAGE; RECOVERY; HYPERGLYCEMIA; MONKEYS; MODEL; FLOW; RATS

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