• Fahad Gul, Eric Peterson, Robert Dejoy, Jeri Albano, Siddique Chaudhary, Paul Valestra, Zurab Azmaiparashvili, Kevin Bryan Lo, Janani Rangaswami, and Gabriel Patarroyo-Aponte.
• Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
• Shock. 2021 Feb 1; 55 (2): 224-229.

ObjectiveTo assess the role for intravenous fluid (IVF) resuscitation in the postarrest 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.DesignRetrospective study design.SettingSingle-center tertiary hospital in Philadelphia, Pennsylvania.PatientsAll patients admitted to the intensive care unit between 2018 and 2019.InterventionsPatients were divided into two groups based on amount of IVF received within 24 h <30 mL/kg (restricted) and over 30 mL/kg (liberal).Measurements And Main ResultsA 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 vs. 6 ± 9 days; P = 0.03) and in the rates of two or more vasopressor use (38% vs. 59%; P = 0.002). End-stage renal disease (ESRD) (OR = 2.39; P = 0.03) and volume of fluids in mL/kg/24 h (OR = 1.025; P < 0.0001) were independently associated with higher vasopressor need. Volume of fluid in mL/kg/24 h (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.ConclusionsA 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.Copyright © 2020 by the Shock Society.

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