Objective

The association between fluid balance and outcomes in patients who underwent out-of-hospital cardiac arrest (OHCA) and received extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. We aimed to examine the above relationship during the first 24 h following intensive care unit (ICU) admission.

Methods

We performed a secondary analysis of the SAVE-J II study, a retrospective multicenter study involving OHCA patients aged ≥ 18 years treated with ECPR between 2013 and 2018 and who received fluid therapy following ICU admission. Fluid balance was calculated based on intravenous fluid administration, blood transfusion, and urine output. The primary outcome was in-hospital mortality. The secondary outcomes included unfavorable outcome (cerebral performance category scores of 3–5 at discharge), acute kidney injury (AKI), and need for renal replacement therapy (RRT).

Results

Overall, 959 patients met our inclusion criteria. In-hospital mortality was 63.6%, and the proportion of unfavorable outcome at discharge was 82.0%. The median fluid balance in the first 24 h following ICU admission was 3673 mL. Multivariable analysis revealed that fluid balance was significantly associated with in-hospital mortality (odds ratio (OR), 1.04; 95% confidence interval (CI), 1.02–1.06; p < 0.001), unfavorable outcome (OR, 1.03; 95% CI, 1.01–1.06; p = 0.005), AKI (OR, 1.04; 95% CI, 1.02–1.05; p < 0.001), and RRT (OR, 1.05; 95% CI, 1.03–1.07; p < 0.001).

Conclusions

Excessive positive fluid balance in the first day following ICU admission was associated with in-hospital mortality, unfavorable outcome, AKI, and RRT in ECPR patients. Further investigation is warranted.

Graphical abstract

中文翻译：

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OHCA 患者急性期体外心肺复苏期间的液体平衡和结局：回顾性多中心队列研究

客观的

接受院外心脏骤停 (OHCA) 和接受体外心肺复苏 (ECPR) 的患者的体液平衡与预后之间的关系仍不清楚。我们的目的是在入住重症监护病房 (ICU) 后的前 24 小时内检查上述关系。

方法

我们对 SAVE-J II 研究进行了二次分析，这是一项回顾性多中心研究，涉及 2013 年至 2018 年间接受 ECPR 治疗且在入住 ICU 后接受液体治疗的 18 岁以上 OHCA 患者。根据静脉输液、输血和尿量计算液体平衡。主要结局是院内死亡率。次要结局包括不良结局（出院时脑功能类别评分为 3-5）、急性肾损伤 (AKI) 和需要肾脏替代治疗 (RRT)。

结果

总体而言，959 名患者符合我们的纳入标准。院内死亡率为63.6%，出院时不良结局比例为82.0%。入住 ICU 后前 24 小时内的中位液体平衡为 3673 mL。多变量分析显示，液体平衡与院内死亡率（比值比 (OR)，1.04；95% 置信区间 (CI)，1.02–1.06；p  < 0.001）、不良结局（OR，1.03；95% CI）显着相关，1.01–1.06；p  = 0.005）、AKI（OR，1.04；95% CI，1.02–1.05；p  < 0.001）和 RRT（OR，1.05；95% CI，1.03–1.07；p  < 0.001）。

结论

入住 ICU 后第一天的液体正平衡过多与 ECPR 患者的院内死亡率、不良结局、AKI 和 RRT 相关。需要进一步调查。

图形概要