Continuous glucose monitoring in a critically ill patient with extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump, and continuous renal replacement therapy: Case report

Abstract

Introduction

Glycemic control in critically ill patients is essential to prevent complications. This study evaluates the use of Continuous Glucose Monitoring (MCG) in a 58-year-old patient with Acute Myocardial Infarction (IAM), complicated by intraventricular communication (CIV) and progression to cardiogenic shock, admitted to the Intensive Care Unit (UCI).

Methods

The patient received advanced hemodynamic support with Extracorporeal Membrane Oxygenation (ECMO), Intra-Aortic Balloon Pump (BCIA), and Continuous Renal Replacement Therapy (TRRC). A Dexcom G7 sensor was used for 10.5 days to monitor glucose levels. Accuracy (Mean Absolute Relative Difference (MARD)) and clinical reliability (Clarke Error Grid) were analyzed, along with the impact on glycemic control and nursing workload.

Results

The CGM system showed preliminarily high accuracy, with a MARD of 7.12%, and 100% of values fell within zones A and B of the Clarke Error Grid. During 98.00% of the monitored time, glucose remained within the target range (70–180 mg/dL), with a mean of 138 mg/dL and no hypoglycaemic episodes. A 27.62% reduction in point-of-care glucose (POC-G) measurements was observed, and the need for capillary glucose testing was eliminated.

Discussion

This case aligns with findings from other authors, demonstrating that CGM in critically ill patients requiring advanced hemodynamic support is accurate, reduces invasive procedures and nursing workload, and improves glycemic control. Larger clinical trials are needed to validate its routine use in the ICU.

Conclusions

CGM in patients with advanced hemodynamic support shows high accuracy and effectiveness, reducing invasiveness and nursing burden, and positioning itself as a promising tool for glycemic management in intensive care, but more clinical trials are needed.