Blood glucose levels in out-of-hospital cardiac arrest undergoing targeted temperature management and ECPR

Aim: Targeted temperature management (TTM) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) has not been fully studied. This study aimed to investigate the association between blood glucose levels during TTM and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing ECPR.

Methods: This was a secondary analysis of the SAVE-J II study, a retrospective, multicenter study of OHCA patients treated with ECPR in Japan. The average inpatient blood glucose levels for days 2-4 was divided into four categories (Category 1: 80-140 mg/dL, Category 2: 140-180 mg/dL, Category 3: 180-300 mg/dL, and Category 4: 300 mg/dL or more). The primary outcome was a favorable neurological status.

Results: Multivariable analyses were performed for 891 enrolled patients. There were 153, 278, 142, and 18 patients in categories 1, 2, 3, and 4, respectively. Category 3 blood glucose levels were significantly more associated with unfavorable outcomes than Category 2 (adjusted OR, 0.45; 95 % CI, 0.24-0.81; p = 0.01). Although not statistically significant, Category 1 blood glucose levels may indicate a potential trend toward favorable neurological outcomes compared to Category 2. [adjusted OR, 1.41; 95 % CI, 0.96-2.08; p = 0.079].

Conclusions: During TTM, blood glucose levels of 180 mg/dL or more were significantly more associated with unfavorable outcomes than those of 140-180 mg/dL, in patients on ECPR. Further studies to evaluate more intensive glucose control than the current target of 140-180 mg/dL are required.