Shock. 2020 Aug 4. doi: 10.1097/SHK.0000000000001617. Online ahead of print.
OBJECTIVE: To assess the role for intravenous fluid (IVF) resuscitation in the post arrest state. Primary outcome was survival to hospital discharge and 30-day mortality. Secondary outcomes were associations with amount of vasopressor use and mechanical ventilation days.
DESIGN: Retrospective study design.
SETTING: Single-center tertiary hospital in Philadelphia, Pennsylvania.
PATIENTS: All patients admitted to the intensive care unit between 2018 and 2019.
INTERVENTIONS: Patients were divided into 2 groups based on amount of IVF received within 24 hours <30 ml/kg (restricted) and over 30 ml/kg (liberal).
MEASUREMENTS AND MAIN RESULTS: A total of 264 patients were included in the study, with 200 included in the restrictive (<30 ml/kg) group and 64 included in the liberal (>30 mg/kg) group. There was no difference in 30-day mortality between the two groups with 146 (73%) deaths in the restrictive groups and 44 (69%) deaths in the liberal group (p = 0.53). There was also no significant difference between those who survived to hospital discharge in the liberal and restrictive groups on Kaplan-Meier analysis (Log-rank = 1.476 p = 0.224). However, there was a significant difference between restrictive and liberal groups with the duration of mechanical ventilation (4 ± 6 days versus 6 ± 9 days; p = 0.03) and in the rates of 2 or more vasopressor use (38% versus 59%; p = 0.002). End stage renal disease (ESRD) (OR = 2.39; p = 0.03) and volume of fluids in ml/kg/24 hours (OR = 1.025; p < 0.0001) were independently associated with higher vasopressor need. Volume of fluid in ml/kg/24 hours (p = 0.01), ESRD (p = 0.015) and chronic obstructive pulmonary disease (p = 0.04) were significantly associated with duration of mechanical ventilation, even after adjusting for demographic factors, comorbidities and mortality.
CONCLUSIONS: A liberal strategy of IVF used in resuscitation after cardiac arrest is not associated with higher mortality. However, it predicts higher vasopressor use and duration of mechanical ventilation.