Impact of pre-arrest glycemic state induced by prolonged fasting on defibrillation requirements: a prospective porcine model of ventricular fibrillation cardiac arrest.

Authors

Zhibo Jia, Hongmeng Dong, Jingyi Wang, Jiawei Gao, Ziyi Li, Yudan Cao, Yue Hu, Junyuan Wu

Published in

Resuscitation plus. Volume 31. Pages 101434. Epub Aug 05, 2026.

Abstract

To investigate whether prolonged fasting-induced lower pre-arrest glycemia above the hypoglycemia alert threshold of 70 mg/dL is associated with defibrillation requirements, CPR duration, and sustained ROSC in a porcine model of ventricular fibrillation cardiac arrest.
Twenty male Landrace pigs were randomized to 36 h or 12 h of solid-food fasting with free access to water before ventricular fibrillation induction. After successful ventricular fibrillation induction, animals underwent 8 min of untreated no-flow cardiac arrest followed by standardized mechanical CPR.
Animals in the prolonged fasting group exhibited significantly lower blood glucose levels at all time points. The 36-h fasting group required more defibrillation shocks than the 12-h fasting group, with median values of 2 shocks (2-3.75) and 1 shock (1-1.75), respectively (P = 0.035). CPR duration was also longer in the 36-h fasting group, with median durations of 344 s (238-784.25) and 191 s (145.75-275), respectively (P = 0.043). Sustained ROSC was achieved in 70% and 90% of animals respectively, with no statistically significant difference between groups (P = 0.582). In univariable Poisson regression, higher pre-arrest blood glucose was associated with fewer defibrillation shocks required, with an incidence rate ratio of 0.980 (95% CI, 0.968-0.993; P = 0.002). During CPR, the 36-h fasting group demonstrated significantly lower MAP (P = 0.035) and mixed venous oxygen saturation (P = 0.030) than the 12-h fasting group.
In this prospective longitudinal porcine model of ventricular fibrillation cardiac arrest, prolonged fasting-induced lower pre-arrest glycemia within the physiological range was associated with increased defibrillation requirements and longer CPR duration, despite similar rates of sustained ROSC. These findings indicate that pre-arrest glycemic and metabolic status may be relevant to resuscitation difficulty.

PMID:
42633369
Bibliographic data and abstract were imported from PubMed on 23 Aug 2026.

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