Association between insulin administration method and six-month neurological outcome in survivors of out-of-hospital cardiac arrest who underwent targeted temperature management

Korean Hypothermia Network investigators

doi:10.1371/journal.pone.0279776

Association between insulin administration method and six-month neurological outcome in survivors of out-of-hospital cardiac arrest who underwent targeted temperature management

Korean Hypothermia Network investigators

Department of Emergency Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

We investigated the association of insulin administration method with the achievement of mean glucose ≤ 180 mg/dL and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors who had hyperglycemia after the return of spontaneous circulation. From a multicenter prospective registry, we extracted the data of adult OHCA survivors who underwent targeted temperature management (TTM) between 2015 and 2018. Blood glucose levels every 4 h after initiating TTM were obtained for 72 h. We divided insulin administration methods into three categories: subcutaneous (SQI), intravenous bolus (IBI), and continuous intravenous (CII). We calculated the mean glucose and standard deviation (SD) of glucose. The primary outcome was the achievement of mean glucose ≤ 180 mg/dL. The secondary outcomes were the 6-month neurological outcome based on the Cerebral Performance Category (CPC) scale (good, CPC 1–2; poor, CPC 3–5), mean glucose, and SD of glucose. Of the 549 patients, 296 (53.9%) achieved mean glucose ≤ 180 mg/dL, and 438 (79.8%) had poor neurological outcomes, 134 (24.4%), 132 (24.0), and 283 (51.5%) were in the SQI, IBI, and CII groups, respectively. The SQI (adjusted odds ratio [aOR], 0.848; 95% confidence intervals [CIs], 0.493–1.461) and IBI (aOR, 0.673; 95% CIs, 0.415–1.091) groups were not associated with mean glucose ≤ 180 mg/dL and the SQI (aOR, 0.660; 95% CIs, 0.335–1.301) and IBI (aOR, 1.757; 95% CIs, 0.867–3.560) groups were not associated with poor neurological outcomes compared to the CII group. The CII (168 mg/dL [147–202]) group had the lowest mean glucose than the SQI (181 mg/dL [156–218]) and IBI (184 mg/ dL [162–216]) groups. The CII (45.0[33.9–63.5]) group had a lower SD of glucose than the IBI (50.8 [39.1–72.0]) group. The insulin administration method was not associated with achieving mean glucose ≤ 180 mg/dL and 6-month neurological outcomes.

Original language	English
Article number	e0279776
Journal	PLoS ONE
Volume	17
Issue number	12 December
DOIs	https://doi.org/10.1371/journal.pone.0279776
State	Published - Dec 2022

Bibliographical note

Publisher Copyright:
© 2022 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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10.1371/journal.pone.0279776

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@article{f2b425876338470faf021fabc3f83349,

title = "Association between insulin administration method and six-month neurological outcome in survivors of out-of-hospital cardiac arrest who underwent targeted temperature management",

abstract = "We investigated the association of insulin administration method with the achievement of mean glucose ≤ 180 mg/dL and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors who had hyperglycemia after the return of spontaneous circulation. From a multicenter prospective registry, we extracted the data of adult OHCA survivors who underwent targeted temperature management (TTM) between 2015 and 2018. Blood glucose levels every 4 h after initiating TTM were obtained for 72 h. We divided insulin administration methods into three categories: subcutaneous (SQI), intravenous bolus (IBI), and continuous intravenous (CII). We calculated the mean glucose and standard deviation (SD) of glucose. The primary outcome was the achievement of mean glucose ≤ 180 mg/dL. The secondary outcomes were the 6-month neurological outcome based on the Cerebral Performance Category (CPC) scale (good, CPC 1–2; poor, CPC 3–5), mean glucose, and SD of glucose. Of the 549 patients, 296 (53.9%) achieved mean glucose ≤ 180 mg/dL, and 438 (79.8%) had poor neurological outcomes, 134 (24.4%), 132 (24.0), and 283 (51.5%) were in the SQI, IBI, and CII groups, respectively. The SQI (adjusted odds ratio [aOR], 0.848; 95% confidence intervals [CIs], 0.493–1.461) and IBI (aOR, 0.673; 95% CIs, 0.415–1.091) groups were not associated with mean glucose ≤ 180 mg/dL and the SQI (aOR, 0.660; 95% CIs, 0.335–1.301) and IBI (aOR, 1.757; 95% CIs, 0.867–3.560) groups were not associated with poor neurological outcomes compared to the CII group. The CII (168 mg/dL [147–202]) group had the lowest mean glucose than the SQI (181 mg/dL [156–218]) and IBI (184 mg/ dL [162–216]) groups. The CII (45.0[33.9–63.5]) group had a lower SD of glucose than the IBI (50.8 [39.1–72.0]) group. The insulin administration method was not associated with achieving mean glucose ≤ 180 mg/dL and 6-month neurological outcomes.",

author = "{Korean Hypothermia Network investigators} and Lee, {Dong Hun} and Lee, {Byung Kook} and Cho, {Yong Soo} and Jung, {Yong Hun} and Lee, {Hyoung Youn} and Jeung, {Kyung Woon} and Youn, {Chun Song} and Kim, {Soo Hyun} and Jeung, {Kyung Woon} and Park, {Kyu Nam} and Chae, {Minjung Kathy} and Kim, {Won Young} and Lee, {Byung Kook} and Lee, {Dong Hoon} and Jang, {Tae Chang} and Lee, {Jae Hoon} and Choi, {Yoon Hee} and You, {Je Sung} and Lee, {Young Hwan} and Cho, {In Soo} and Kim, {Su Jin} and Lee, {Jong Seok} and Kim, {Yong Hwan} and Sim, {Min Seob} and Jonghwan Shin and Park, {Yoo Seok} and Moon, {Hyung Jun} and Jeong, {Won Jung} and Oh, {Joo Suk} and Choi, {Seung Pill} and Cha, {Kyoung Chul}",

note = "Publisher Copyright: {\textcopyright} 2022 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2022",

month = dec,

doi = "10.1371/journal.pone.0279776",

language = "English",

volume = "17",

journal = "PLoS ONE",

issn = "1932-6203",

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number = "12 December",

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TY - JOUR

T1 - Association between insulin administration method and six-month neurological outcome in survivors of out-of-hospital cardiac arrest who underwent targeted temperature management

AU - Korean Hypothermia Network investigators

AU - Lee, Dong Hun

AU - Lee, Byung Kook

AU - Cho, Yong Soo

AU - Jung, Yong Hun

AU - Lee, Hyoung Youn

AU - Jeung, Kyung Woon

AU - Youn, Chun Song

AU - Kim, Soo Hyun

AU - Jeung, Kyung Woon

AU - Park, Kyu Nam

AU - Chae, Minjung Kathy

AU - Kim, Won Young

AU - Lee, Byung Kook

AU - Lee, Dong Hoon

AU - Jang, Tae Chang

AU - Lee, Jae Hoon

AU - Choi, Yoon Hee

AU - You, Je Sung

AU - Lee, Young Hwan

AU - Cho, In Soo

AU - Kim, Su Jin

AU - Lee, Jong Seok

AU - Kim, Yong Hwan

AU - Sim, Min Seob

AU - Shin, Jonghwan

AU - Park, Yoo Seok

AU - Moon, Hyung Jun

AU - Jeong, Won Jung

AU - Oh, Joo Suk

AU - Choi, Seung Pill

AU - Cha, Kyoung Chul

N1 - Publisher Copyright: © 2022 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2022/12

Y1 - 2022/12

N2 - We investigated the association of insulin administration method with the achievement of mean glucose ≤ 180 mg/dL and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors who had hyperglycemia after the return of spontaneous circulation. From a multicenter prospective registry, we extracted the data of adult OHCA survivors who underwent targeted temperature management (TTM) between 2015 and 2018. Blood glucose levels every 4 h after initiating TTM were obtained for 72 h. We divided insulin administration methods into three categories: subcutaneous (SQI), intravenous bolus (IBI), and continuous intravenous (CII). We calculated the mean glucose and standard deviation (SD) of glucose. The primary outcome was the achievement of mean glucose ≤ 180 mg/dL. The secondary outcomes were the 6-month neurological outcome based on the Cerebral Performance Category (CPC) scale (good, CPC 1–2; poor, CPC 3–5), mean glucose, and SD of glucose. Of the 549 patients, 296 (53.9%) achieved mean glucose ≤ 180 mg/dL, and 438 (79.8%) had poor neurological outcomes, 134 (24.4%), 132 (24.0), and 283 (51.5%) were in the SQI, IBI, and CII groups, respectively. The SQI (adjusted odds ratio [aOR], 0.848; 95% confidence intervals [CIs], 0.493–1.461) and IBI (aOR, 0.673; 95% CIs, 0.415–1.091) groups were not associated with mean glucose ≤ 180 mg/dL and the SQI (aOR, 0.660; 95% CIs, 0.335–1.301) and IBI (aOR, 1.757; 95% CIs, 0.867–3.560) groups were not associated with poor neurological outcomes compared to the CII group. The CII (168 mg/dL [147–202]) group had the lowest mean glucose than the SQI (181 mg/dL [156–218]) and IBI (184 mg/ dL [162–216]) groups. The CII (45.0[33.9–63.5]) group had a lower SD of glucose than the IBI (50.8 [39.1–72.0]) group. The insulin administration method was not associated with achieving mean glucose ≤ 180 mg/dL and 6-month neurological outcomes.

AB - We investigated the association of insulin administration method with the achievement of mean glucose ≤ 180 mg/dL and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors who had hyperglycemia after the return of spontaneous circulation. From a multicenter prospective registry, we extracted the data of adult OHCA survivors who underwent targeted temperature management (TTM) between 2015 and 2018. Blood glucose levels every 4 h after initiating TTM were obtained for 72 h. We divided insulin administration methods into three categories: subcutaneous (SQI), intravenous bolus (IBI), and continuous intravenous (CII). We calculated the mean glucose and standard deviation (SD) of glucose. The primary outcome was the achievement of mean glucose ≤ 180 mg/dL. The secondary outcomes were the 6-month neurological outcome based on the Cerebral Performance Category (CPC) scale (good, CPC 1–2; poor, CPC 3–5), mean glucose, and SD of glucose. Of the 549 patients, 296 (53.9%) achieved mean glucose ≤ 180 mg/dL, and 438 (79.8%) had poor neurological outcomes, 134 (24.4%), 132 (24.0), and 283 (51.5%) were in the SQI, IBI, and CII groups, respectively. The SQI (adjusted odds ratio [aOR], 0.848; 95% confidence intervals [CIs], 0.493–1.461) and IBI (aOR, 0.673; 95% CIs, 0.415–1.091) groups were not associated with mean glucose ≤ 180 mg/dL and the SQI (aOR, 0.660; 95% CIs, 0.335–1.301) and IBI (aOR, 1.757; 95% CIs, 0.867–3.560) groups were not associated with poor neurological outcomes compared to the CII group. The CII (168 mg/dL [147–202]) group had the lowest mean glucose than the SQI (181 mg/dL [156–218]) and IBI (184 mg/ dL [162–216]) groups. The CII (45.0[33.9–63.5]) group had a lower SD of glucose than the IBI (50.8 [39.1–72.0]) group. The insulin administration method was not associated with achieving mean glucose ≤ 180 mg/dL and 6-month neurological outcomes.

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DO - 10.1371/journal.pone.0279776

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JO - PLoS ONE

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ER -

Association between insulin administration method and six-month neurological outcome in survivors of out-of-hospital cardiac arrest who underwent targeted temperature management

Abstract

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