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The following is a summary of “Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit,” published in the April 2025 issue of Critical Care by Renaudier et al. 

Researchers conducted a retrospective study to explore the relationship between positive fluid balance and outcomes following out-of-hospital cardiac arrest (OHCA).  

They carried out a multicenter study across 17 intensive care units (ICU), enrolling consecutive adult OHCA cases between August 2020 and June 2022. The main outcome was 90-day survival (primary endpoint). To analyze outcomes, a multivariate Cox regression, propensity score matching, and landmark analysis was used supported by multiple sensitivity analyses.  

The results showed that among 816 OHCA cases, 74% had a positive fluid balance, and 291 individuals (36%) survived at 90 days. Positive fluid balance was linked to higher mortality after multivariate adjustment (HR = 1.8 [1.3–2.3], P < 0.001) in propensity-matched pairs (n = 193, HR = 1.6 [1.1–2.1], P = 0.005) and in landmark analysis. A dose-response relationship was observed between fluid balance and mortality. Those with positive fluid balance required renal replacement therapy more often (10% vs 2%, P = 0.001) and had a lower minimum P_a O₂ /F_i O₂ ratio over the first 7 days (158 vs 180, P < 0.001).  

Investigators concluded that a positive fluid balance had been consistently associated with a worst outcome in patients post OHCA.   

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05391-x