Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 17:25:101037.
doi: 10.1016/j.resplu.2025.101037. eCollection 2025 Sep.

Fluid balance after cardiac arrest: Any impact on outcome? Insights from the MIMIC IV database

Juliette Didier  1   2 , Juliette Murris  2   3   4 , Hélène Schopper  2   3   4 , Emmanuelle Guérin  1   2   5 , Nolwen Flajoliet  1 , Marine Amiot  1 , Bertrand Hermann  1   2   6 , Stéphane Germain  5 , Alain Cariou  2   7 , Jean-Luc Diehl  1   2   8 , Sandrine Katsahian  2   4   9   10 , Nicolas Bréchot  1   2   5
Affiliations

Fluid balance after cardiac arrest: Any impact on outcome? Insights from the MIMIC IV database

Juliette Didier et al. Resusc Plus. .

Abstract

Background: Fluid balance is closely associated with outcomes in septic shock. Post-cardiac arrest (CA) shock, which accounts for one-third of deaths after CA, shares many pathophysiological features with sepsis. However, the impact of fluid balance has not been analyzed in this setting. This study aimed to assess the impact of fluid balance on mortality during post-CA shock.

Methods: This retrospective study used the Medical Information Mart for Intensive Care (MIMIC)-IV database. Fluid balance was quantified during the first 72 h. Multivariate logistic-regression analysis identified factors associated with early (by day 3) mortality.

Results: Among the 1800 patients resuscitated from CA, 868 (68 %) developed post-CA shock. Of these, 801 were analyzed; 334 (42 %) died within 3 days. Early non-survivors had a higher median fluid balance (+3289 mL [25th; 75th IQR + 502; +5806]) than early survivors (+930 mL [-2677; +4353]) (P < 0.001). Positive fluid balance independently predicted death by day 3 (OR 2.23, 95 % CI [1.29; 3.14]; P = 0.005). Mortality increased significantly with increasing fluid balance, especially from 1000 mL and upwards (OR 4.11, 95 % CI [2.32; 2.47]; P < 0.001). Other factors independently associated with early mortality included age >66 years, maximum catecholamines dose, and peak serum lactate.

Conclusions: These findings confirm that fluid balance is associated with early mortality during post-CA shock.

Keywords: Cardiac arrest; Fluid balance; Post-resuscitation; Shock; Vascular leakage; Vasoactive-inotropic score.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘Dr Bréchot participates in an F4-Pharma advisory board, without any financial competing interest. He received a grant from the French Ministry of Health for a study evaluating FX06, a drug under development aiming at controlling vascular leakage. He receives fees from Findimmune and Getinge, outside the scope of this study.’.

Figures

Fig. 1
Fig. 1
Flow chart of the study.
Fig. 2
Fig. 2
Tukey’s box plots of detailed fluid inputs and outputs in mL over the first 3 days post-cardiac arrest, of day-3 survivors and non-survivors. NS, non-significant. **P < 0.01, ***P < 0.001.
Fig. 3
Fig. 3
Kaplan–Meier estimated survival probability according to cumulative fluid balance over days 0–3 of post-cardiac arrest shock, with shaded 95 % confidence interval.
Fig. 4
Fig. 4
Kaplan–Meier estimated survival probability according to maximal vasoactive-inotropic score (VIS) over days 0–3 of post-cardiac arrest shock, with shaded 95 % confidence interval.
See this image and copyright information in PMC

References

    1. Gräsner J.-T., Lefering R., Koster R.W., et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016;105:188–195. doi: 10.1016/j.resuscitation.2016.06.004. - DOI - PubMed
    1. Benjamin E.J., Blaha M.J., Chiuve S.E., et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/CIR.0000000000000485. - DOI - PMC - PubMed
    1. Perkins G.D., Ji C., Deakin C.D., et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med. 2018;379:711–721. doi: 10.1056/NEJMoa1806842. - DOI - PubMed
    1. Neumar R.W., Nolan J.P., Adrie C., et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation. 2008;118:2452–2483. doi: 10.1161/CIRCULATIONAHA.108.190652. - DOI - PubMed
    1. Jozwiak M., Bougouin W., Geri G., Grimaldi D., Cariou A. Post-resuscitation shock: recent advances in pathophysiology and treatment. Ann Intensive Care. 2020;10:170. doi: 10.1186/s13613-020-00788-z. - DOI - PMC - PubMed

LinkOut - more resources