[OPTIMIZATION OF GLUCOSE METABOLISM IN PATIENTS UNDERGOING THERAPEUTIC HYPOTHERMIA AFTER SUDDEN CARDIAC ARREST]. / Optimización del metabolismo glucémico: DE LOS PACIENTES SOMETIDOS A HIPOTERMIA TERAPÉUTICA TRAS UNA PARADA CARDIORRESPIRATORIA.

OBJECTIVE: Therapeutic hypothermia (TH) is recommended to improve survival and neurologic prognosis in sudden cardiac arrest (SCA) survivors. There are few data aboutglycemic levels in these patients. The aim of this study is to evaluate the glycemic control using a specific protocol in this group ofpeople. METHOD: A retrospective analysis of the patients receiving TH in our institution, between January 2010 and March 2013,. was performed. Baseline characteristics, in-hospital prognosis and glycemic levels during different stages of the TH were analyzed. RESULTS: From a total of 55 patients suffering a SCA, 49 patients underwent TH and received a specific insulin protocol. The mean age was 57.5 ± 12.8 years, the main cause of SCA was ischemic (76%) and ventricular fibrillation was the most frequent first rhythm detected (55%). Regarding glycemic alterations as each stage of TH, a high rate of glycemic alteration was observed in the induction stage, decreasing after starting the insulin protocol (induction stage: 95.9%; maintenance stage: 89.8%; rewarming stage: 69.4%; p = 0.001). With respectto clinicresults, there were low rates of severe hypoglycemia (12%), in-hospital mortality (20%) and anoxic encephalopathy (27%), with a high rate of infections (75%). CONCLUSIONS: The implementation of a specific insulin protocol in patients receiving TH contributes to improve the blood glucose levels. Further studies are needed to evaluate the clinical impact of these protocols in this group ofpatients.

Optimización del metabolismo glucémico de los pacientes sometidos a hipotermia terapéutica tras una parada cardiorrespiratoria / Optimization of glucose metabolism in patients undergoing therapeutic hypothermia after sudden cardiac arrest

Objectivo. La hipotermia terapéutica (HT) se recomienda para mejorar el pronóstico vital y neurológico en pacientes que sobreviven a una parada cardiorrespiratoria (PCR). Existen pocos datos acerca de los niveles glucémicos en estos pacientes. El objetivo del estudio es evaluar el control glucémico mediante un protocolo específico para estas personas. Método. Se realizó un análisis retrospectivo de los pacientes que recibieron HT en nuestra institución entre enero de 2010 y marzo de 2013. Se analizaron las características basales, el pronóstico intrahospitalario y la glucemia en las distintas fases de la HT. Resultados. De un total de 55 pacientes que presentaron PCR, 49 se sometieron a HT y recibieron un protocolo específico de control glucémico. La edad media fue 57.5 ± 12.8 años, la principal causa de la PCR fue isquémica (76 %) y la fibrilación ventricular fue el primer ritmo monitorizado más frecuente (55 %). Respecto a las alteraciones glucémicas según cada fase de la HT, se objetivó un elevado porcentaje inicial de alteraciones glucídicas que pudo disminuirse tras la instauración de nuestro protocolo (fase de inducción: 95.9 %; fase de mantenimiento: 89.8 %; fase de recalentamiento: 69.4 %; p = 0.001). En los resultados clínicos destaca un bajo porcentaje de hipoglucemias severas (12 %), mortalidad intrahospitalaria (20 %) y encefalopatía anóxica (27 %), pero un elevado porcentaje de infecciones (75 %). Conclusiones. La instauración de un protocolo de control glucémico específico en los pacientes que reciben HT por una PCR parece mejorar el control glucémico. Se requieren más estudios para evaluar el impacto clínico de esta terapia en estos pacientes (AU)

Objective. Therapeutic hypothermia (TH) is recommended to improve survival and neurologic prognosis in sudden cardiac arrest (SCA) survivors. There are few data about glycemic levels in these patients. The aim of this study is to evaluate the glycemic control using a specific protocol in this group of people. Methods. A retrospective analysis of the patients receiving TH in our institution, between January 2010 and March 2013, was performed. Baseline characteristics, in-hospital prognosis and glycemic levels during different stages of the TH were analyzed. Results. From a total of 55 patients suffering a SCA, 49 patients underwent TH and received a specific insulin protocol. The mean age was 57.5 ± 12.8 years, the main cause of SCA was ischemic (76 %) and ventricular fibrillation was the most frequent first rhythm detected (55 %). Regarding glycemic alterations as each stage of TH, a high rate of glycemic alteration was observed in the induction stage, decreasing after starting the insulin protocol (induction stage: 95.9 %; maintenance stage: 89.8 %; rewarming stage: 69.4 %; p = 0.001). With respect to clinic results, there were low rates of severe hypoglycemia (12 %), in-hospital mortality (20 %) and anoxic encephalopathy (27 %), with a high rate of infections (75 %). Conclusions. The implementation of a specific insulin protocol in patients receiving TH contributes to improve the blood glucose levels. Further studies are needed to evaluate the clinical impact of these protocols in this group of patients (AU)