Renaudier Marie, Lascarrou Jean-Baptiste, Chelly Jonathan, Lesieur Olivier, Bourenne Jérémy, Jaubert Paul, Paul Marine, Muller Grégoire, Leprovost Pierre, Klein Thomas, Yansli Mélany, Daubin Cédric, Petit Matthieu, Pichon Nicolas, Cour Martin, Sboui Ghada, Geri Guillaume, Cariou Alain, Bougouin Wulfran
Medical Intensive Care Unit, AP-HP Centre, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
Université Paris Cité, Paris, France.
Crit Care. 2025 Apr 14;29(1):152. doi: 10.1186/s13054-025-05391-x.
Although shock following cardiac arrest is common and contributes significantly to mortality, the influence of the modalities used to manage the hemodynamic situation, particularly with regard to fluid balance, remains unclear. We evaluated the association between positive fluid balance and outcome after out-of-hospital cardiac arrest (OHCA).
We conducted a multicenter study from August 2020 to June 2022, which consecutively enrolled adult OHCA patients in 17 intensive care units. The primary endpoint was 90-day survival. Multivariate Cox analysis, propensity score matching and landmark analysis were performed, along with several sensitivity analyses.
Of the 816 patients included in our study, 74% had a positive fluid balance, and 291 of 816 patients (36%) were alive at 90-day. A positive fluid balance was associated with mortality after adjusted multivariate analysis (HR = 1.8 [1.3 - 2.3], p < 0.001), after propensity score matching (n = 193 matched patient pairs, HR = 1.6 [1.1 - 2.1], p = 0.005) and after landmark analysis. We reported a dose-dependent association between fluid balance and mortality. Patients with a positive fluid balance were more likely to need renal replacement therapy (10% vs. 2%, p = 0.001) and had a lower minimum PO/FO ratio in the first seven days (158 vs. 180, p < 0.001).
After cardiac arrest, a positive fluid balance is consistently associated with a worse outcome. Pending further data, a restrictive fluid therapy strategy may be beneficial in post-OHCA patients.
ClinicalTrial.gov cohort AfterROSC-1 NCT04167891 registered November 13th, 2019, ethics committees 2019-A01378-49 and CPP-SMIV 190901.
尽管心脏骤停后休克很常见且对死亡率有显著影响，但用于管理血流动力学状况的方式的影响，尤其是在液体平衡方面，仍不清楚。我们评估了院外心脏骤停（OHCA）后正性液体平衡与预后之间的关联。
我们在2020年8月至2022年6月进行了一项多中心研究，连续纳入了17个重症监护病房的成年OHCA患者。主要终点是90天生存率。进行了多变量Cox分析、倾向评分匹配和标志性分析，以及多项敏感性分析。
在我们研究纳入的816例患者中，74%有正性液体平衡，816例患者中有291例（36%）在90天时存活。经过调整的多变量分析后（HR = 1.8 [1.3 - 2.3]，p < 0.001）、倾向评分匹配后（n = 193对匹配患者，HR = 1.6 [1.1 - 2.1]，p = 0.005）以及标志性分析后，正性液体平衡与死亡率相关。我们报告了液体平衡与死亡率之间的剂量依赖性关联。正性液体平衡的患者更可能需要肾脏替代治疗（10% 对2%，p = 0.001），并且在头七天的最低PO/FO比值更低（158对1
