Abstract 11: Is Therapeutic Hypothermia After Cardiac Arrest Harmful For Diabetic Patients?
Mild induced hypothermia (MIH) improves survival and neurological outcome in comatose patients after resuscitated cardiac arrest due to ventricular fibrillation. Diabetes correlates with poor prognosis of critically ill. MIH increases hyperglycaemia, however detrimental effects of MIH in diabetic patients are not known. We assessed the hypothesis that survival improvement with MIH is better in non-diabetic patients than in diabetic. We compared hospital mortality between a group of 83 consecutive patients after cardiac arrest, treated with MIH (Dec 2003 to Dec 2005) and a group of 70 consecutive historical controls not treated with MIH (Jan 2001 to Nov 2003). Demographic and baseline data were similar in both groups. MIH significantly reduced mortality (−28.7%) in non-diabetic patients and non-significantly increased mortality (+20.8%) in the diabetic patients. Mortality was similar between diabetic and non-diabetic patients before implementation of MIH. After implementation of MIH however, the mortality is significantly higher among diabetic patients. The mechanism of this observation is not clear. Morning glucose levels were comparable before and after implementation of MIH. Diabetes was not associated with more complications of hypothermia. Causes of death were similar between diabetic and non-diabetic patients. Limitations of our study include small number of patients and non-randomised design (we belive randomisation would not be ethical). Further research is necessary. We conclude that MIH after cardiac arrest significantly improves survival in non-diabetic patients, but not in the diabetic patients. A different hypothermia protocol may be needed for diabetics.