SHOCK最新文献

{"title":"PROGNOSTIC IMPLICATIONS OF CHANGES IN PLATELET TRAJECTORIES IN PATIENTS WITH SEPSIS: A RETROSPECTIVE ANALYSIS USING THE MEDICAL INFORMATION MART FOR INTENSIVE CARE IV DATABASE.","authors":"Yingxin Wang, Jiaqian Wu, Tenghao Shao, Dan Su, Xin Ma, Zhanbiao Yu, Ning Li","doi":"10.1097/SHK.0000000000002493","DOIUrl":"10.1097/SHK.0000000000002493","url":null,"abstract":"<p><strong>Abstract: </strong>Objective: Patients with sepsis often experience reductions or increases in platelet counts, but the implications of these temporal patterns on prognosis remain unclear. The aim of this study was to investigate the impact of changes in platelet trajectories on the clinical prognosis of sepsis. Methods: This study was a retrospective analysis using data from the Medical Information Mart for Intensive Care IV database. Patients with sepsis were identified from the database, and their platelet trajectories were categorized into four distinct models based on the changes in platelet counts over a period of 14 days after diagnosis of sepsis. The effect of these trajectories on patient prognosis was subsequently evaluated. Results: A total of 15,250 patients with sepsis were included to construct a model, and the following four distinct platelet count trajectories were identified: normal platelet levels (phenotype 1); persistently low platelet levels (phenotype 2); gradually increasing platelet levels exceeding the normal range (phenotype 3); and consistently significantly elevated platelet levels (phenotype 4). Statistically significant differences were found in the 28-day mortality, in-hospital mortality, and 90-day mortality among the four phenotypes. Multivariate regression analysis showed that compared to the group with normal platelet levels (phenotype 1), the group with persistently low platelet levels (phenotype 2) had higher in-hospital mortality (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.16-1.54), 28-day mortality (OR = 1.69, 95% CI: 1.47-1.94), and 90-day mortality (OR = 1.50, 95% CI: 1.32-1.69). There was no difference in in-hospital mortality between phenotypes 3 and 4 compared to phenotype 1, although phenotype 4 showed an increase in 28-day mortality ( P < 0.05), and phenotype 3 showed a decreasing trend in 90-day mortality ( P < 0.05). The results of inverse probability weighting adjusted by regression were basically consistent with the above findings, except that there was no statistical difference in 28-day mortality between phenotype 4 and phenotype 1. In the subgroups based on age, weight, and antiplatelet drugs or therapies, there was an interaction between platelet levels and these factors. Conclusions: In patients with sepsis, a decrease in platelet count is associated with increased mortality, while a moderate increase in platelet count can reduce 90-day mortality. However, for patients with persistently elevated platelet counts, caution is advised when using antiplatelet drugs or therapies, as it may increase mortality.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"371-378"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DOES WHOLE BLOOD RESUSCITATION INCREASE RISK FOR VENOUS THROMBOEMBOLISM IN TRAUMA PATIENTS? A COMPARISON OF WHOLE BLOOD VERSUS COMPONENT THERAPY IN 3,468 PATIENTS.","authors":"Brittany Hout, Jan-Michael Van Gent, Thomas Clements, Rebecca Rausa, Carter Kaminski, Thaddeus Puzio, Julie Rizzo, Bryan Cotton","doi":"10.1097/SHK.0000000000002508","DOIUrl":"10.1097/SHK.0000000000002508","url":null,"abstract":"<p><strong>Abstract: </strong>Background: Whole blood (WB) resuscitation has been shown to provide mortality benefit. However, the impact of whole blood transfusions on the risk of venous thromboembolism (VTE) remains unclear. We sought to compare the VTE risk in patients resuscitated with WB versus component therapy (COMP). Methods: Trauma patients aged 18 and older, admitted to two Level 1 trauma centers between 2016 and 2021, who received at least one unit of emergency-release blood products were identified. Clinical and transfusion data were collected. Patients that received any WB during resuscitation were compared to those who received only COMP therapy. The primary outcome was VTE incidence, defined as deep vein thrombosis and/or pulmonary embolism. Results: 3,468 patients met inclusion criteria (WB: 1,775, COMP: 1,693). WB patients were more likely to be male (82 vs. 68%), receive tranexamic acid (21 vs. 16%), and had higher Injury Severity Score (26 vs. 19; all P < 0.001). WB patients exhibited less hospital-free days (11 vs. 15), intensive care unit-free days (23 vs. 25), and 30-day survival (74 vs. 84; all P < 0.001). The WB group had lower VTE incidence (6 vs. 10%, P < 0.001). Logistic regression revealed WB was protective against VTE (OR 0.70, 95% CI 0.54-091, P = 0.009), while red blood cell transfusions and tranexamic acid (TXA) exposure increased VTE risk. Discussion: Using WB as part of resuscitation was associated with a 30% reduction in VTE, while TXA and red blood cell transfusion increased VTE risk. Further research is needed to evaluate VTE risk with empiric use of TXA in the setting of early WB transfusion capability.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"406-410"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"UNDERSTANDING HEMODYNAMIC INCOHERENCE: MECHANISMS, PHENOTYPES, AND IMPLICATIONS FOR TREATMENT.","authors":"Lin Huang, Qiaobin Huang, Weiquan Ma, Hong Yang","doi":"10.1097/SHK.0000000000002507","DOIUrl":"10.1097/SHK.0000000000002507","url":null,"abstract":"<p><strong>Abstract: </strong>The reversal of microcirculation dysfunction is crucial for assessing the success of shock resuscitation and significantly influences patient prognosis. However, hemodynamic incoherence is observed when microcirculatory dysfunction persists despite the restoration of macrocirculatory function after resuscitation. Recent advancements in technology have enabled bedside assessment of microcirculation in shock patients, allowing for direct visualization of microcirculatory morphology and quantitative evaluation of its functional status. This article reviews the pathophysiological mechanisms that lead to hemodynamic incoherence. It also introduces the current understanding and classification framework for the different phenotypes of hemodynamic incoherence. Existing evidence indicates that the diverse mechanisms leading to microcirculatory disorders result in varied manifestations among patients experiencing hemodynamic incoherence, highlighting the heterogeneity of this population. Some classification frameworks have been proposed to enhance our understanding of these phenotypes. By integrating pathophysiological mechanisms, clinical symptoms, indicators of macrocirculation, microcirculation, tissue metabolism, and biomarkers, we can summarize certain clinical features of phenotypes in hemodynamic incoherence to form a conceptual framework. Additionally, strategies for creating targeted treatments based on different phenotypes require further validation.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"342-350"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NETWORK ANALYSIS OF SINGLE-NUCLEOTIDE POLYMORPHISMS ASSOCIATED WITH ABERRANT INFLAMMATION IN TRAUMA PATIENTS SUGGESTS A ROLE FOR VESICLE-ASSOCIATED INFLAMMATORY PROGRAMS INVOLVING CD55.","authors":"Fayten El-Dehaibi, Ruben Zamora, Jinling Yin, Rami A Namas, Timothy R Billiar, Yoram Vodovotz","doi":"10.1097/SHK.0000000000002523","DOIUrl":"10.1097/SHK.0000000000002523","url":null,"abstract":"","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":"63 3","pages":"505"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE EFFECT OF CATECHOLAMINE VERSUS NONCATECHOLAMINE VASOPRESSORS ON RENAL FUNCTION AND RECOVERY IN VASODILATORY SHOCK: A SYSTEMATIC REVIEW OF PRECLINICAL AND CLINICAL STUDIES.","authors":"Jake Vernon-Elliot, Shruti Goradia, Rinaldo Bellomo, Yugeesh R Lankadeva, Louise M Burrell, Emily J See","doi":"10.1097/SHK.0000000000002515","DOIUrl":"10.1097/SHK.0000000000002515","url":null,"abstract":"<p><strong>Abstract: </strong>Background: Acute kidney injury (AKI) is a common complication of vasodilatory shock. AKI is associated with an increased risk of death, prolonged hospital stays, and subsequent transition to chronic kidney disease. Catecholamines have historically been used as the first-line vasopressors for vasodilatory shock; however, they may adversely affect renal function and recovery. Objectives: To compare the effects of catecholamine and noncatecholamine vasopressors on AKI risk and recovery in preclinical and clinical studies of vasodilatory shock. Methods: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched to identify studies reporting renal outcomes associated with catecholamine (norepinephrine, epinephrine, metaraminol, phenylephrine, dopamine) and noncatecholamine vasopressors (vasopressin, angiotensin II), in preclinical models or adult cohorts of vasodilatory shock. Two independent reviewers screened studies and extracted data using a prespecified form for qualitative synthesis and risk of bias assessment. Results: Of 3,504 citations, 90 studies were eligible for inclusion: 41 preclinical studies, 17 nonrandomized clinical studies, 28 randomized clinical studies, and 4 post-hoc analyses. Risk of bias was generally low in preclinical studies and low to moderate in clinical studies. In preclinical studies, catecholamine vasopressors exacerbated medullary hypoxia and intrarenal inflammation compared to noncatecholamine vasopressors. In clinical studies, catecholamines were associated with higher serum creatinine, lower urine output, and increased requirements for renal replacement therapy compared to noncatecholamine vasopressors. In patients on high-dose catecholamines, adjunctive angiotensin II was associated with improved renal replacement therapy liberation. Conclusion: Preclinical and clinical studies suggest that noncatecholamine vasopressors may confer renal benefits compared to catecholamine vasopressors. These hypothesis-generating observations suggest the need for comparative studies focused on renal outcomes. Systematic Review Registration : PROSPERO 2024 CRD42024527773.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"351-362"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PREDICTING SEPSIS-INDUCED HYPOTENSION PATIENT ATTRIBUTES FOR RESTRICTIVE VERSUS LIBERAL FLUID STRATEGY.","authors":"Pulakesh Upadhyaya, Jeffrey Wang, Daniel T Mathew, Ayman Ali, Simon Tallowin, Eric Gann, Felipe A Lisboa, Seth A Schobel, Eric A Elster, Timothy G Buchman, Christopher J Dente, Rishikesan Kamaleswaran","doi":"10.1097/SHK.0000000000002506","DOIUrl":"10.1097/SHK.0000000000002506","url":null,"abstract":"<p><strong>Abstract: </strong>Background : Patients with sepsis-induced hypotension are generally treated with a combination of intravenous fluids and vasopressors. The attributes of patients receiving a liberal compared to a restrictive fluid strategy have not been fully characterized. We use machine learning (ML) techniques to identify key predictors of restrictive versus liberal fluids strategy, and the likelihood of receiving each strategy in distinct patient phenotypes. Methods: We performed a retrospective observational study of patients at Emory University Hospital from 2014 to 2021 that were hypotensive, met Sepsis-3 criteria, and received at least 1 L of intravenous crystalloid fluids. We excluded patients with nonseptic etiologies of hypotension. Supervised ML techniques were used to identify key predictors for the two strategies. Additionally, subset analyses were performed on patients with pneumonia, congestive heart failure (CHF), or chronic kidney disease (CKD). Using unsupervised ML techniques, we also identified three distinct sepsis-induced hypotension phenotypes and evaluated their likelihood of receiving either strategy. Results: We identified N = 15,292 patients and randomly split them into training (n = 12,233) and validation (n = 3,059) datasets. XGBoost was the most accurate model (AUC: 0.84) for predicting the strategies. While worse oxygenation was the strongest predictor of utilizing a restrictive fluid strategy, top predictors of a liberal fluid strategy included higher pulse and blood urea nitrogen. In subset analyses, CHF, CKD, and pneumonia were predictive of restrictive fluid strategy. We identified three distinct sepsis-induced hypotension phenotypes: 1) mild organ injury, 2) severe hypoxemia, and 3) renal dysfunction. Conclusions: We identified key predictors of restrictive versus liberal fluids strategy and distinct patient phenotypes for sepsis-induced hypotension.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"399-405"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MONOCYTE ANISOCYTOSIS IS ASSOCIATED WITH SEPSIS IN CHILDREN WITH SUSPECTED INFECTION.","authors":"Lael M Yonker, Oluwakemi Badaki-Makun, Bryan Alvarez-Carcamo, Cody Cross, Yanki Okuducu, Lori Appleman, Jaime Greatorex, Rosemary E Onu, Christine Santos, Rachel Petherbridge, Brody H Foy, Diana Careaga, Melissa Naiman, Iris Castro, Logan Haller, Lauren B Guthrie, John M Higgins, Kent B Lewandrowski, Daniel Irimia","doi":"10.1097/SHK.0000000000002502","DOIUrl":"10.1097/SHK.0000000000002502","url":null,"abstract":"<p><strong>Abstract: </strong>Background: Early, accurate determination of disease severity in an emergency setting is paramount for improving patient outcomes and healthcare costs. Monocyte anisocytosis, quantified as monocyte distribution width (MDW), has been shown to correspond with immune dysregulation. We hypothesize that MDW is broadly associated with illness severity related to sepsis and serious infection in children. Methods: We designed a retrospective study to analyze MDW, as measured by UniCel DxH 900 analyzer, on whole blood samples that were collected from children presenting for medical care between April 2020 and September 2022. SIRS criteria and Pediatric Sequential Organ Failure Assessment (pSOFA) scores were calculated, and source of infection was documented. Outcomes were compared by t test or ANOVA, and receiver operating characteristic (ROC) curves assessed accuracy of MDW in identifying sepsis in children. Results: We analyzed samples from 394 children presenting with illness to two pediatric medical centers. MDW was significantly higher in children with sepsis (28.2 ± 7.8) than children with suspected or confirmed infection who did not display signs of sepsis (21.5 ± 5.2). An ROC curve comparing MDW of children with sepsis against infected children without sepsis displayed an area under the curve of 0.78, suggesting MDW may serve as a useful tool in identifying children with sepsis. Discussion: When children present to the urgent care/emergency setting with signs of infection, MDW may serve as a prompt tool to aid clinicians in identifying those who are at high risk for severe illness and require closer monitoring/intervention compared to those who may be safely discharged home.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"385-389"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SR3677 IS HEPATOPROTECTIVE IN MURINE LIVER ISCHEMIA/REPERFUSION INJURY: POTENTIAL ROLE OF BNIP3L/NIX (BCL2/ADENOVIRUS E1B 19 KDA PROTEIN-INTERACTING PROTEIN 3-LIKE).","authors":"Avinash Naraiah Mukkala, Vida Maksimoska, Emma Noble, Menachem Ailenberg, Raluca Petrut, Rachel Goldfarb, Andras Kapus, Katalin Szaszi, Ori David Rotstein","doi":"10.1097/SHK.0000000000002527","DOIUrl":"10.1097/SHK.0000000000002527","url":null,"abstract":"<p><strong>Abstract: </strong>SR3677, a highly selective rho-associated protein kinase 2 inhibitor, administered prior to liver ischemia/reperfusion injury, induced hepatoprotection in both wild-type and Parkin2-/- mice. Experiments in hepatocytes identified BNIP3L/NIX, as a potential mediator of the hepatoprotective effects of SR3677.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"499-502"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INDUCTION OF EARLY PULMONARY SENESCENCE IN EXPERIMENTAL SEPSIS.","authors":"Martin Mösenlechner, Daniela Schlösser, Sonja Braumüller, Lena Dörfer, Marco Mannes, Rawan Kawach, Gudrun Strauss, Christoph Q Schmidt, Ludmila Lupu, Markus S Huber-Lang","doi":"10.1097/SHK.0000000000002512","DOIUrl":"10.1097/SHK.0000000000002512","url":null,"abstract":"<p><strong>Abstract: </strong>Background: Sepsis continues to pose a significant threat to human life and represents a substantial financial burden. In addition to replicative stress resulting from telomeric loss, recent studies have identified multiple factors contributing to cell cycle arrest. Furthermore, our understanding of pathways associated with cellular senescence, such as CD47-mediated suppression of efferocytosis, has expanded. However, beyond in vitro experiments, the impact of cell stress during complex systemic illnesses, including sepsis, remains poorly understood. Consequently, we conducted an investigation into molecular alterations related to senescence-associated pulmonary mechanisms during experimental nonpulmonary sepsis. Methods: Male C57BL/6JRj mice were anesthetized and subjected to either control conditions (sham) or cecal ligation and puncture (CLP) to induce sepsis. Twenty-four hours or 7 d after CLP, animals were killed, and blood, bronchoalveolar fluids, and lungs were harvested and analyzed for morphological and biochemical changes. Results: Histological damage in pulmonary tissue, as well as increases in plasma levels of surfactant protein D, indicated development of alveolar-focused acute lung injury after CLP. Additionally, we observed a significant upregulation of the CD47-QPCTL-SHP-1 axis in lungs of septic mice. Whereas the expression of p16, a marker primarily indicating manifested forms of senescence, was decreased after CLP, the early marker of cellular senescence, p21, was increased in the lungs during sepsis. Later, at 7 d after CLP, pulmonary expression of CD47 and QPCTL-1 was decreased, whereas SHP-1 was significantly enhanced. Conclusion: Our findings suggest an activation of senescent-associated pathways during experimental sepsis. However, expanding the experiments to other organ systems and in vivo long-term models are necessary to further evaluate the sustained mechanisms and immunopathophysiological consequences of cellular senescence triggered by septic organ injury.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"448-455"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FLUID THERAPY DURING AND AFTER CARDIOPULMONARY RESUSCITATION FOR NONTRAUMATIC CARDIAC ARREST: A SYSTEMATIC REVIEW OF EVIDENCE FROM PRECLINICAL AND CLINICAL STUDIES.","authors":"Ali Jendoubi, Quentin De Roux, Minh-Pierre Lê, Stefania Magnoni, Bijan Ghaleh, Renaud Tissier, Matthias Kohlhauer, Nicolas Mongardon","doi":"10.1097/SHK.0000000000002519","DOIUrl":"10.1097/SHK.0000000000002519","url":null,"abstract":"<p><strong>Abstract: </strong>Background: Several therapeutic interventions are recommended during and after cardiopulmonary resuscitation (CPR) in order to optimize oxygen delivery and improve survival rates. Among these interventions, there is a clinical practice heterogeneity regarding use of fluids in this setting. The optimal fluid resuscitation strategy remains controversial. This systematic review aimed to summarize the current knowledge regarding type, dosing, and safety of fluid therapy during and after CPR in animal models and human studies. Methods: A systematic search of the literature within PubMed and Embase was conducted from database inception to June 2024. Preclinical and clinical studies involving adult patients with nontraumatic cardiac arrest describing fluid resuscitation strategies and reporting at least one outcome of interest were included: achievement of return of spontaneous circulation, survival to hospital admission or discharge, incidence of acute kidney injury and neurological outcome. Studies assessing intra-arrest bicarbonate buffer therapy and/or using cold fluid infusions to induce hypothermia were excluded. Results: Twenty-nine studies met inclusion criteria, including 10 clinical studies and 19 animal models. The effects of fluid therapy during CPR are underexplored in clinical research. Hypertonic saline therapy has emerged as an alternative resuscitative fluid during CPR in animal models. In postresuscitation setting, balanced crystalloids have been increasingly assessed. There are no clinical studies investigating the impact of early goal directed fluid resuscitation on outcomes in particular shock resolution and neurological recovery. Conclusions: There is a call for clinical evidence to assess the efficacy and safety of fluid resuscitation during CPR, to define the place of hypertonic saline therapy during and after resuscitation and finally to implement early goal-directed fluid therapy as a tailored intervention of the postarrest care bundle. Review registration: ROSPERO; No.: CRD42024571617; URL: https://www.crd.york.ac.uk/prospero/.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":"63 3","pages":"363-370"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}