Effects of using dextrose administration and outcome in out-of-hospital cardiac arrest patients with hypoglycemia during cardiopulmonary resuscitation.

Hypoglycemia is a reversible cause of cardiac arrest that can be identified during cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the effect of prehospital intravenous (IV) dextrose administration during CPR on the outcomes of patients with OHCA with hypoglycemia compared with those without hypoglycemia who did not receive dextrose. This was a retrospective single-center cohort study including adult patients with nontraumatic OHCA aged ≥ 18 years who were assisted by Vajira Emergency Medical Service and delivered to the emergency department of the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, between January 1, 2019, and June 30, 2023. Patients were divided into dextrose and nondextrose groups. The primary outcome was sustained return of spontaneous circulation (ROSC) at the scene, and the secondary outcome was survival to hospital discharge. Subgroup analyses were conducted by stratification according to diabetes status. Inverse probability of treatment weighting (IPTW) based on propensity scores and multiple logistic regression analysis were performed for statistical evaluation. Among 246 eligible patients, sustained return of spontaneous circulation (ROSC) at the scene occurred in 45.5% of the dextrose group and 44.0% of the nondextrose group, while 30-day survival was 25.6% and 12.8%, respectively. After inverse probability of treatment weighting, dextrose administration was not significantly associated with sustained ROSC at the scene (adjusted risk ratio 1.13, 95% confidence interval 0.80–1.59; p = 0.484) but was associated with a higher likelihood of 30-day survival (adjusted risk ratio 2.38, 95% confidence interval 1.18–4.80; p = 0.015). In subgroup analyses, patients with diabetes who received dextrose had markedly higher 30-day survival compared with those who did not (36.4% vs. 6.5%; adjusted risk ratio 18.86, 95% confidence interval 3.82–93.10; p < 0.001), whereas no significant benefit was observed among patients without diabetes (23.2% vs. 14.9%; adjusted risk ratio 1.81, 95% confidence interval 0.92–3.53; p = 0.084). Dextrose administration during CPR in OHCA patients with hypoglycemia was not associated with improved sustained ROSC at the scene but was linked to better survival to hospital discharge, possibly due to benefits on post-resuscitation physiology rather than immediate resuscitation success.