ROSC after giving D50 in cardiac arrest?

[NomadicMedic]

I can't tell you how many fall/seizure calls we have that are upgraded to Cardiac Arrest one the all taker digs in a little more. Luckily, those calls AE usually dispatched as delta calls, so medics are enroute anyway.

 

[mycrofft]

Roger the two above.

 

[zzyzx]

I don't see how you can get an answer to your questions since no one is ever going administer only dextrose on a cardiac arrest. Good topic though. Would love to read your lecture.

 

[KellyBracket]

... Good topic though. Would love to read your lecture.

If it works out, it will be a 2.5 minute rant on a #FOAMED podcast - I'll update this thread with a link when it comes out!

 

[Merck]

It seems unlikely that a cardiac arrest would have a solely hypoglycemic etiology, even given the possibility presented of a prolonged QT. I wonder if some of the anecdotal effect of D50W administration might not be due not to the sugary-goodness but rather to what is essentially a fluid bolus in patients amenable to such therapy in cardiac arrest (i.e. ROSC from a PEA with an element of hypovolemia). The osmolarity of D50W is on the extreme side (around 2,600, I believe). This likely causes some decent fluid shift and possibly a temporary bump in intravascular volume before the sugar is taken up by cells - a process likely delayed in arrest or low-flow states. Just a thought.

 

[onrope]

It seems unlikely that a cardiac arrest would have a solely hypoglycemic etiology, even given the possibility presented of a prolonged QT. I wonder if some of the anecdotal effect of D50W administration might not be due not to the sugary-goodness but rather to what is essentially a fluid bolus in patients amenable to such therapy in cardiac arrest (i.e. ROSC from a PEA with an element of hypovolemia). The osmolarity of D50W is on the extreme side (around 2,600, I believe). This likely causes some decent fluid shift and possibly a temporary bump in intravascular volume before the sugar is taken up by cells - a process likely delayed in arrest or low-flow states. Just a thought.

Not sure what your protocols are but take a gander at mine:
http://www.sbcounty.gov/icema/main/ViewFile.aspx?DocID=1522

300cc fluid challenge is frontline in PEA/asystole arrest. I am not sure what everyone elses protocols look like in regards to fluid bolus in cardiac arrest. Down the "list" is BGL analysis and opiate od consideration. Then again lidocaine is also on there after 2 cycles of cpr for v-fib/tach

 

[Merck]

I understand that most PEA protocols would have a bolus of some volume to account for the possibility that the issue is one of preload/straight-up hypovolemia. I'm just saying that if D50W is given, the benefit may be derived from the osmotic pull and subsequent repletion of intravascular volume rather than the sugar itself.

 

[Carlos Danger]

I understand that most PEA protocols would have a bolus of some volume to account for the possibility that the issue is one of preload/straight-up hypovolemia. I'm just saying that if D50W is given, the benefit may be derived from the osmotic pull and subsequent repletion of intravascular volume rather than the sugar itself.

That is an interesting and plausible hypothesis.