Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.
Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
Clin Res Cardiol. 2021 Sep;110(9):1484-1492. doi: 10.1007/s00392-021-01862-7. Epub 2021 May 4.
Patients with cardiogenic shock or cardiac arrest undergoing venoarterial extracorporeal membrane oxygenation (V-A ECMO) frequently present with blood glucose levels out of normal range. The clinical relevance of such findings in the context of V-A ECMO is unknown. We therefore investigated the prognostic relevance of blood glucose at time of cannulation for V-A ECMO.
We conducted a single-center retrospective registry study. All patients receiving V-A ECMO from October 2010 to January 2020 were included if blood glucose level at time of cannulation were documented. Patients were divided in five groups according to the initial blood glucose level ranging from hypoglycemic (< 80 mg/dl), normoglycemic (80-140 mg/dl), to mild (141-240 mg/dl), moderate (241-400 mg/dl), and severe (> 400 mg/dl) hyperglycemia, respectively. Clinical presentation, arterial blood gas analysis, and survival were compared between the groups.
392 patients met inclusion criteria. Median age was 62 years (51.5-70.0), SAPS II at admission was 54 (43.5-63.0), and 108/392 (27.6%) were female. 131/392 were discharged alive (hospital survival 33.4%). At time of cannulation, survivors had higher pH, hemoglobin, calcium, bicarbonate but lower potassium and lactate levels compared to non-survivors (all p < 0.01). Outcome of patients diagnosed with particularly high (> 400 mg/dl) and low (< 80 mg/dl) blood glucose at time of V-A ECMO cannulation, respectively, was worse compared to patients with normoglycemic, mildly or moderately elevated values (p = 0.02). Glucose was independently associated with poor outcome after adjustment for other predictors of survival and persisted in all investigated subgroups.
Arterial blood glucose at time of V-A ECMO cannulation predicts in-hospital survival of patients with cardiac shock or after ECPR. Whether dysglycemia represents a potential therapeutic target requires further evaluation in prospective studies.
行静脉-动脉体外膜肺氧合（V-A ECMO）的心源休克或心搏骤停患者的血糖水平经常超出正常范围。在 V-A ECMO 背景下，这种发现的临床相关性尚不清楚。因此，我们研究了 V-A ECMO 置管时血糖的预后相关性。
我们进行了一项单中心回顾性登记研究。纳入 2010 年 10 月至 2020 年 1 月期间 V-A ECMO 置管时记录血糖水平的所有患者。根据初始血糖水平将患者分为五组，范围从低血糖（<80mg/dl）、正常血糖（80-140mg/dl）、轻度（141-240mg/dl）、中度（241-400mg/dl）和重度（>400mg/dl）高血糖。比较各组之间的临床表现、动脉血气分析和存活率。
392 名患者符合纳入标准。中位年龄为 62 岁（51.5-70.0），入院时 SAPS II 为 54（43.5-63.0），108/392（27.6%）为女性。392 名患者中有 131 名存活出院（院内存活率为 33.4%）。在置管时，与非幸存者相比，幸存者的 pH、血红蛋白、钙和碳酸氢盐水平更高，而钾和乳酸水平更低（均 p<0.01）。在 V-A ECMO 置管时分别诊断为血糖极高（>400mg/dl）和极低（<80mg/dl）的患者的预后较血糖正常、轻度或中度升高的患者更差（p=0.02）。在校正其他生存预测因素后，血糖与不良预后独立相关，并在所有研究亚组中持续存在。
V-A ECMO 置管时的动脉血糖可预测心源性休克或 ECPR 后的院内存活率。血糖异常是否代表潜在的治疗靶点，需要进一步在前瞻性研究中评估。
