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Objective: Elevated blood glucose is associated with poor outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Our aim was to determine whether strict glucose control with intensive insulin treatment improves outcome of OHCA patients. Design: A randomized, controlled trial. Setting: Two university hospital intensive care units. Patients: Ninety patients resuscitated from OHCA with ventricular fibrillation detected as the initial rhythm were treated with therapeutic hypothermia. Interventions: Patients were randomized into two treatment groups: a strict glucose control group (SGC group), with a blood glucose target of 4-6 mmol/l, or a moderate glucose control group (MGC group), with a blood glucose target of 6-8 mmol/l. Both groups were treated with insulin infusion for 48 h, because a control group with no treatment was considered unethical. Measurements and results: Baseline data were similar in both groups. In the SGC group 71% of the glucose measurements were within the target range compared with 41% in the MGC group. Median glucose was 5.0 mmol/l in the SGC group and 6.4 mmol/l in the MGC group. The occurrence of moderate hypoglycemic episodes was 18% in the SGC group and 2% in the MGC group (p = 0.008). No episodes of severe hypoglycemia occurred. Mortality by day 30 was 33% in the SGC group and 35% in the MGC group (p = 0.846); the difference was 2% (95% CI -18% to +22%). Conclusions: We found no additional survival benefit from strict glucose control compared with moderate glucose control with a target between 6 and 8 mmol/l in OHCA patients. Keywords Randomized controlled trial * Resuscitation * Glucose * Hypothermia * Mortality * Enolase, Introduction One major aim of intensive care after cardiac arrest is to alleviate the hypoxic-ischemic brain injury that evolves during the reperfusion period. Several post-resuscitation factors, such as low blood [...]

Byline: Tuomas Oksanen (1), Tero Varpula (1), Markus B. Skrifvars (2), Ville Pettila (2), Maaret Castren (3) Author Affiliation: (1) Intensive Care Units, Jorvi Hospital, Helsinki University Hospital, Turuntie 150, 02740, Espoo, Finland (2) Intensive Care Units, Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland (3) Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, 11883, Stockholm, Sweden Article History: Registration Date: 29/02/2008 Accepted Date: 16/02/2008 Online Date: 21/03/2008 Article note: This reply refers to the comment available at:a- http://dx.doi.org/10.1007/s00134-008-1075-y.