LAUSR

Introduction/Hypothesis: Several factors such as initial electrocardiography shockable rhythm, short low-flow time, young age, and cardiogenic etiology have been reported to be associated with favorable neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). Hyperglycemia after return of spontaneous circulation has been associated with poor neurological outcomes; however, the relationship between blood glucose on admission and neurological outcomes is still unknown. Blood glucose increases after injury as part of the normal physiological response. We hypothesized that increased blood glucose during resuscitation is a predictor of favorable neurologic outcomes. To address this hypothesis, the present study aimed to examine the association between blood glucose levels on admission and neurological outcomes in OHCA patients receiving ECPR. Methods: This retrospective study was performed at a single center, and it included OHCA patients who received ECPR between January 2013 and October 2018. Patients were divided into three groups according to their blood glucose IQR on admission. The primary outcome was unfavorable neurological outcome at hospital discharge (i.e., cerebral performance categories of 3–5). Multivariate logistic regression analysis was performed to determine the association between blood glucose levels on admission and unfavorable neurological outcomes. Results: The study included 125 patients, of which 37.6% of the patients survived to hospital discharge, and among these, 17.6% had favorable neurological outcomes. Among all study patients, the median blood glucose level on admission was 294 mg/ dL [IQR, 238–367]. Patients were divided into the following three groups according to their blood glucose IQR on admission: low (<238), middle (238≤, <367), and high blood glucose groups (≥367). The frequency of unfavorable outcomes was 93.3%, 78.1%, and 80.7% in the low, middle, and high blood glucose groups, respectively. Multivariate analysis showed that low blood glucose was significantly associated with unfavorable neurological outcomes (odds ratio 5.29; 95% confidence interval: 1.19–39.41; p = 0.03). Conclusions: Low blood glucose on admission is associated with unfavorable neurological outcomes in OHCA patients receiving ECPR.