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Strict versus moderate glucose control after resuscitation from ventricular fibrillation

Authors :
Oksanen, Tuomas
Skrifvars, Markus B.
Varpula, Tero
Kuitunen, Anne
Pettila, Ville
Nurmi, Jouni
Castren, Maaret
Source :
Intensive Care Medicine. December, 2007, Vol. 33 Issue 12, p2093, 8 p.
Publication Year :
2007

Abstract

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<br />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 [...]

Details

Language :
English
ISSN :
03424642
Volume :
33
Issue :
12
Database :
Gale General OneFile
Journal :
Intensive Care Medicine
Publication Type :
Academic Journal
Accession number :
edsgcl.171791981
Full Text :
https://doi.org/10.1007/s00134-007-0876-8