Give me less sugar: how to manage glucose levels in post-anoxic injury?

Excerpt

Despite recent advances in the management of comatose survivors after cardiac arrest (CA), a high proportion of these patients will eventually die because of severe cardiovascular failure or extended brain injury [1]. The combination of these haemodynamic and neurological alterations with a post-CA systemic inflammatory response, similar to that observed in sepsis, is commonly defined as the “post-cardiac arrest syndrome” [2]. However, beyond these abnormalities, the development of metabolic derangements, such as hyperglycaemia, can also potentially contribute to secondary brain injury and poor neurological outcome [3]. Indeed, experimental studies suggest that elevated blood glucose levels after the return of spontaneous circulation may exacerbate post-anoxic injury [4, 5]; nevertheless, the impact of hyperglycaemia in this specific clinical setting remains unclear. …