Extracorporeal Cardiopulmonary Resuscitation in Hypothermic Cardiac Arrest: Severe Hypoglycemia Does Not Preclude Survival With Good Neurologic Outcome

Abstract

Objective: Prolonged hypoglycemia can cause irreversible brain damage. Clinicians may thus be reluctant to initiate extracorporeal cardiopulmonary resuscitation in hypothermic cardiac arrest patients with severe hypoglycemia. The aim of this study was to evaluate the survival rate with good neurologic outcomes of patients with hypothermic cardiac arrest and severe hypoglycemia. Design: Retrospective study. Setting: Multicenter study based on data from the HELP Registry. Participants: Adult victims of accidental hypothermia with a core temperature ≤28°C and cardiac arrest who had undergone extracorporeal rewarming between January 2014 and June 2024 were included in the study. Interventions: Patients with initial blood glucose concentration <3 mmol/L (<54 mg/dL) (severe hypoglycemia) were compared with those with glucose level ≥3 mmol/L (≥54 mg/dL). Survival to hospital discharge with favorable neurologic outcome was considered the primary outcome. Measurements and Main Results: The study population consisted of 127 patients, of whom 21 (17%) presented with glucose concentration <3 mmol/L (<54 mg/dL) on admission to the hospital. By hospital discharge, 8 of 21 patients (38%) with severe hypoglycemia had survived in good neurologic condition. The lowest blood glucose level in a patient who survived without neurologic deficit was 0.9 mmol/L (16 mg/dL). There was no statistically significant difference in survival rates between patients with and without severe hypoglycemia (38% v 43%, p = 0.7). Conclusions: In patients with hypothermic cardiac arrest, severe hypoglycemia on admission to the hospital does not rule out survival with good neurologic outcomes after extracorporeal rewarming.