Implementation of an intraoperative glycemic control protocol for cardiac surgery in a high-acuity academic medical center: an observational study

Feasibility and precision of subcutaneous continuous glucose monitoring in patients undergoing CABG surgery

OBJECTIVES

To evaluate if subcutaneous continuous glucose monitoring (sCGM) is feasible in cardiac surgery and if reliable glucose values are reported under hypothermic extracorporeal circulation.

DESIGN

Feasibility trial.

SETTING

University hospital.

PARTICIPANTS

Ten consecutive patients undergoing coronary artery bypass grafting.

INTERVENTIONS

Prior to surgery, during hypothermic extracorporeal bypass, and 48 hours postoperatively, arterial blood glucose samples were compared with sCGM every 30 minutes. Statistical analysis utilized Clarke's error grid and Bland-Altman plot.

MEASUREMENTS AND MAIN RESULTS

Three hundred fifty-one pairs of glucose measurements were recorded including 59 during hypothermic extracorporeal circulation. Agreement between these measurements was acceptable, with a regression line slope of 0.88 and an offset of 17.4 (p = 0.87). Error grid analysis indicated a safe margin of 99.1% within zone A (no clinical action needed) or zone B (values would not lead to inappropriate treatment). Only 0.9% were plotted in zone D (potentially dangerous failure). Measurements during hypothermic extracorporeal circulation were comparable. Correlation coefficient was 0.760. The offset regression line was more pronounced (50.9) with a flatter slope (0.640). Within the error grid all plot values were in zone A or B.

CONCLUSIONS

sCGM compared with arterial blood gas glucose monitoring under hypothermic extracorporeal circulation appears to be feasible and reliable.