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Observational Study
. 2025 Apr 14;29(1):152.
doi: 10.1186/s13054-025-05391-x.

Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit

Marie Renaudier  1   2 , Jean-Baptiste Lascarrou  3 , Jonathan Chelly  4 , Olivier Lesieur  5   6 , Jérémy Bourenne  7 , Paul Jaubert  8 , Marine Paul  9 , Grégoire Muller  10   11   12 , Pierre Leprovost  13 , Thomas Klein  14 , Mélany Yansli  15 , Cédric Daubin  16 , Matthieu Petit  17   18 , Nicolas Pichon  19 , Martin Cour  20 , Ghada Sboui  21 , Guillaume Geri  22 , Alain Cariou  23   5   24 , Wulfran Bougouin  24   25
Affiliations
Observational Study

Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit

Marie Renaudier et al. Crit Care. .

Abstract

Background: Although shock following cardiac arrest is common and contributes significantly to mortality, the influence of the modalities used to manage the hemodynamic situation, particularly with regard to fluid balance, remains unclear. We evaluated the association between positive fluid balance and outcome after out-of-hospital cardiac arrest (OHCA).

Methods: We conducted a multicenter study from August 2020 to June 2022, which consecutively enrolled adult OHCA patients in 17 intensive care units. The primary endpoint was 90-day survival. Multivariate Cox analysis, propensity score matching and landmark analysis were performed, along with several sensitivity analyses.

Results: Of the 816 patients included in our study, 74% had a positive fluid balance, and 291 of 816 patients (36%) were alive at 90-day. A positive fluid balance was associated with mortality after adjusted multivariate analysis (HR = 1.8 [1.3 - 2.3], p < 0.001), after propensity score matching (n = 193 matched patient pairs, HR = 1.6 [1.1 - 2.1], p = 0.005) and after landmark analysis. We reported a dose-dependent association between fluid balance and mortality. Patients with a positive fluid balance were more likely to need renal replacement therapy (10% vs. 2%, p = 0.001) and had a lower minimum PaO2/FiO2 ratio in the first seven days (158 vs. 180, p < 0.001).

Conclusions: After cardiac arrest, a positive fluid balance is consistently associated with a worse outcome. Pending further data, a restrictive fluid therapy strategy may be beneficial in post-OHCA patients.

Trial registration: ClinicalTrial.gov cohort AfterROSC-1 NCT04167891 registered November 13th, 2019, ethics committees 2019-A01378-49 and CPP-SMIV 190901.

Keywords: Epidemiology; Fluid balance; Out-of-hospital cardiac arrest; Outcome.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted according to the Strengthening The Reporting of OBservational studies in Epidemiology guidelines, and the cohort was registered on ClinicalTrial.gov before the first patient was enrolled (Cohort AfterROSC-1, NCT04167891 registered November 13th, 2019)(8). The research protocol was approved by the relevant ethics committees (2019-A01378-49; CPP-SMIV 190901) and the French data protection authorities, according to the principles of the Declaration of Helsinki. According to French law, patients or relatives were informed of their inclusion in this study, an information notice was provided to them, and their non-opposition was documented. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient flow chart. OHCA out-of-hospital cardiac arrest
Fig. 2
Fig. 2
Fluid intake, diuresis, and fluid balance during the first 7 days after OHCA between survivors and non-survivors at day 90. Legend: survivors are shown in blue, non-survivors in light gray. An asterisk (*) indicates a significant difference between the two groups. a: fluid intake in mL/kg, b: diuresis in mL/kg, c: fluid balance in mL/kg
Fig. 3
Fig. 3
Kaplan Meier curves representing 90-day survival according to cumulative fluid balance at day-7. Red curve represents patients with a positive fluid balance and blue curve with a negative fluid balance
See this image and copyright information in PMC

References

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