FLUID THERAPY DURING AND AFTER CARDIOPULMONARY RESUSCITATION FOR NONTRAUMATIC CARDIAC ARREST: A SYSTEMATIC REVIEW OF EVIDENCE FROM PRECLINICAL AND CLINICAL STUDIES.

Abstract: 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/.