19 Mechanisms of early glucose regulation disturbance after out-of-hospital-cardiac arrest: an observational prospective study. (16th April 2018)

• Record Type: Journal Article
• Authors: Vihonen, Hanna; Kuisma, Markku; Salo, Ari; Ångerman, Susanne; Pietiläinen, Kirsi; Nurmi, Jouni
• Is Part Of: BMJ open. Volume 8:Supplement 1(2018)
• Page Start: A7
• Page End: A7
• Publication Date: 2018-04-16
• Subjects: Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-EMS.19
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Aim: Ultra-acute hyperglycaemia is common after out-of hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) and it is associated with increased mortality. The mechanisms of the ultra-acute hyperglycaemia are not known. Because these probably differ from stress induced hyperglycaemia, we aimed to study the changes in glucose metabolism mediators during prehospital post-resuscitation phase. Method: We included 30 successfully resuscitated patients in two physician-staffed prehospital critical care units in this observational study. Blood was drawn at the time of ROSC and again at the arrival to the hospital. Insulin, glucagon, glucagon-like peptide 1 (GLP-1) were measured from both samples. Additionally, interleukin-6 (IL-6), cortisol and HbA1C were measured from the hospital sample. Results: 28 patients qualified for final study (71% were without diabetes). Median time interval between the samples was 96 min (IQR 85–119). At the time of ROSC patients were hyperglycaemic (11.2 mmol/L, IQR 8.8–15.7) with insulin and GLP-1 concentrations corresponding fasting levels (10.1 mU/l, IQR 4.2–25.2 and 6.3 ng/ml, IQR 5.2–9.0, respectively). Glucagon was in normal range (141 ng/L, IQR 105–240). Median glucose change during prehospital phase was −2.2 mmol/L, (IQR −3.6 to −0.2). No consistent change in the hormone concentrations was observed during prehospital phase. No significant correlation was observed between change in plasma glucose and change of insulin (p=0.13, r=0.30), glucagon (p=0.17, r=0.29), or GLP-1 (p=0.15, r=0.32) nor with IL-6 (p=0.75, r=(−0.07)), cortisol p=0.52, r=0.13) or HbA1c (p=0.08-r=0.34) respectively. Conclusion: Hyperglycaemia is common immediately after OHCA. High level of variability between patients was observed in the hormonal responses and no specific hormonal mechanisms for hyperglycaemia was identified. However, possibly due to global ischaemic insult, hyperglycaemia in the early post-resuscitation period seems to differ from those commonly linked to SIH. Conflict of interest: None Funding: None