Skip Ribbon Commands
Skip to main content
SharePoint

PublicComment

 Feedback

If you have any comments or questions on this page, please email us at:
 

Glucose Control After Resuscitation

Question Type:
Intervention
Full Question:
Among adults with ROSC after cardiac arrest in any setting (P), does does a specific target range for blood glucose management (eg, strict 4–6 mmol/L)  (I), compared with compared with any other target range  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year (O)?
Consensus on Science:
For the critical outcome of survival to hospital discharge, there was moderate-quality evidence (downgraded for risk of bias due to lack of blinding) from 1 RCT of 90 subjects showing reduced 30-day mortality (RR, 0.94; 95% CI, 0.53–1.68) when subjects were assigned to strict (4–6 mmol/L) versus moderate (6–8 mmol/L) glucose control.(Oksanen 2007, 2093) One before-and-after observational study of 119 subjects provided very-low-quality evidence (downgraded for multiple potential confounding variables) of reduced in-hospital mortality (RR, 0.46; 95% CI, 0.28–0.76) after implementation of a bundle of care that included defined glucose management (5–8 mmol/L).(Sunde 2007, 29) The effect of glucose management cannot be separated from the effects of other parts of the bundle.
Treatment Recommendation:
In making this recommendation, we considered the lack of evidence that the approach to glucose management chosen for other critical care populations should be modified for the post–cardiac arrest patients. Moreover, we noted that strict glycemic control is labor intensive, and in other populations, implementation of strict glycemic control is associated with increased episodes of hypoglycemia, which might be detrimental. Avoiding hypoglycemia was considered more important than the unproven benefits of treating moderate hyperglycemia.
CoSTR Attachments:
GlucosePICO_draft2.doc    
GRADEtable.tiff    
ILCOR Data Collection Form Glucose jz.xls    
SOFtable.tiff    
SummarofBiasAssessmentsGlucose.xls    

 Contact Us

 
If you have any comments or questions on this page, please email us at: