Volume therapy for cardiac arrest: a systematic review and meta-analysis

Area of Science:

• Critical Care Medicine
• Cardiology
• Emergency Medicine

Background:

• Intravascular volume therapy is crucial in managing cardiac arrest and post-arrest care.
• Evidence on optimal volume therapy strategies during and after cardiac arrest remains limited.
• Current guidelines recommend fluid administration, but specific types and timing are debated.

Purpose of the Study:

• To systematically review and meta-analyze evidence on intra-cardiac arrest and post-cardiac arrest intravascular volume therapy in adults and children.
• To assess the effectiveness of different volume therapy interventions in various cardiac arrest scenarios.
• To evaluate the certainty of evidence for volume therapy in cardiac arrest management.

Main Methods:

• Systematic search of Ovid Medline, Embase, and Cochrane Library up to October 30, 2025.
• Inclusion of randomized trials and non-randomized studies on volume therapy during and after cardiac arrest.
• Data extraction, risk of bias assessment (using GRADE methodology), and meta-analysis where appropriate.

Main Results:

• Included 58 articles: 14 trials (4815 adults) and 44 observational studies (710,118 patients, including pediatric and mixed populations).
• No significant differences in outcomes were found for specific interventions (e.g., hypertonic saline, cold crystalloids) in non-traumatic or traumatic intra-arrest settings.
• Post-arrest trials also showed no outcome differences between cold crystalloids and balanced/unbalanced crystalloids; evidence certainty was low to very low.

Conclusions:

• No trials directly compared volume therapy versus no volume therapy during cardiopulmonary resuscitation.
• Available trials in adults demonstrated no significant clinical outcome differences between various volume therapy strategies.
• Further randomized trials are essential to clarify the role of intra- and post-cardiac arrest volume therapy.