ABSTRACTS
Influence of Intra-arrest Glucose Level on Patient OutcomesAuthor: Michael Hubble PhD, MBA, NRP | Assistant Professor | Assistant Professor Associate Authors: Houston, Sara, MHS, NRP | Taylor, Stephen, PHD, MHS, Paramedic, FAEMS | Martin, Melisa, EdD, MHS, Paramedic | Kaplan, Ginny, PhD, MHS, Paramedic, FAEMS | Kearns, Randy, DHA, MSA, FACHE, FRSPH
Introduction Cardiac arrest leads to an array of metabolic disturbances, including glucose metabolism. Intra-arrest blood glucose level (BGL) is rarely reported in the out-of-hospital cardiac arrest (OHCA) literature and its influence on patient outcomes is yet to be conclusively established. Objective To describe the interrelationship among intra-arrest BGL, prehospital dextrose administration, and short-term patient outcomes. Methods A retrospective analysis of the 2020 ESO Data Collaborative Annual Research dataset was conducted that included adults who experienced non-traumatic arrests prior to EMS arrival and for whom at least one intra-arrest BGL was measured. Logistic regression was used to determine the association between BGL and patient outcomes while controlling for potential confounding variables. In this analysis, BGL was modeled with 7 categories representing visually distinct bins of the unadjusted probability of ROSC stratified by the first intra-arrest glucose measurement. Results Data were available for 16,847 patients, of which a presumed cardiac etiology was present in 81.6%, followed by respiratory/asphyxia(9.6%), drug overdose(5.0%), and other(3.7%). A majority(62.0%) were males with a mean age of 63.5(±16.7) and a mean BGL of 184.4(±104.8). An initial shockable rhythm was present in 20.0%, while 25.8% received bystander CPR and 35.9% attained ROSC. Compared to patients with BGLs of 161-300mg/dL, patients with ≤50mg/dL, 51-110mg/dL, 111-160mg/dL, 351-430mg/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, we found no statistically significant difference in the odds of ROSC between those who received dextrose and those who did not. For cumulative BGL values above the 90 mg/dL threshold, intra-arrest dextrose administration was associated with a lower odds of ROSC. Conclusion 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 are warranted to further elucidate the interrelationship between BGL, dextrose administration, and longer-term patient outcomes.
|
