Fluid management strategies during and after cardiopulmonary resuscitation: evidence trade-offs between restrictive and liberal fluid therapy strategies_West China Medical Journal

Authors：

CHAI Wenyun ^1,2 , XU Chongxi ^1,2 , YAO Peng ^1,2 , MA Wen ^1,2 ,  CAO Yu ^1,2

1. Department of Emergency Medicine, Institute of Disaster Medicine and Institute of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Disaster Medical Center, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CAO Yu, Email: caoyu@wchscu.cn

Keywords：

Cardiac arrest; return of spontaneous circulation; fluid management; restrictive fluid therapy; liberal fluid therapy

DOI：

10.7507/1002-0179.202510043

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

During and after cardiopulmonary resuscitation, patients often have circulatory dysfunction and tissue hypoperfusion. Fluid management strategy has an important impact on hemodynamic stability and prognosis. Restrictive fluid therapy can reduce the risk of fluid overload and brain edema by accurately controlling the volume input. Although liberal fluid therapy strategy can rapidly restore blood volume, it may lead to poor prognosis. This paper summarizes the characteristics of the two strategies in volume management, reperfusion injury prevention and control, and neuroprotection, aiming to provide evidence-based reference for the development of a goal-oriented individualized fluid management program.

Citation： CHAI Wenyun, XU Chongxi, YAO Peng, MA Wen, CAO Yu. Fluid management strategies during and after cardiopulmonary resuscitation: evidence trade-offs between restrictive and liberal fluid therapy strategies. West China Medical Journal, 2025, 40(11): 1854-1858. doi: 10.7507/1002-0179.202510043 Copy

1.	Soar J, B?ttiger BW, Carli P, et al. European Resuscitation Council guidelines 2021: adult advanced life support. Resuscitation, 2021, 161: 115-151.
2.	Hirsch KG, Amorim E, Coppler PJ, et al. Part 11: post-cardiac arrest care: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(Suppl 2): S673-S718.
3.	Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation, 2008, 118(23): 2452-2483.
4.	Jendoubi A, De Roux Q, Lê MP, et al. Fluid therapy during and after cardiopulmonary resuscitation for nontraumatic cardiac arrest: a systematic review of evidence from preclinical and clinical studies. Shock, 2025, 63(3): 363-370.
5.	Jentzer JC, Chonde MD, Dezfulian C. Myocardial dysfunction and shock after cardiac arrest. Biomed Res Int, 2015, 2015: 314796.
6.	Joffre J, Radermacher P, Kallel H, et al. Vascular leakage during circulatory failure: physiopathology, impact and treatments. Ann Intensive Care, 2025, 15(1): 79.
7.	Langeland H, Dam?s JK, Mollnes TE, et al. The inflammatory response is related to circulatory failure after out-of-hospital cardiac arrest: a prospective cohort study. Resuscitation, 2022, 170: 115-125.
8.	Kosta S, Dauby PC. Frank-starling mechanism, fluid responsiveness, and length-dependent activation: unravelling the multiscale behaviors with an in silico analysis. PLoS Comput Biol, 2021, 17(10): e1009469.
9.	Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001, 345(19): 1368-1377.
10.	Zhang MQ, Macala KF, Fox-Robichaud A, et al. Sex- and gender-dependent differences in clinical and preclinical sepsis. Shock, 2021, 56(2): 178-187.
11.	Renaudier M, Lascarrou JB, Chelly J, et al. Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit. Crit Care, 2025, 29(1): 152.
12.	Gul F, Peterson E, Dejoy R, et al. Association between intravenous fluid resuscitation and hospital mortality in post cardiac arrest patients: a retrospective study. Shock, 2021, 55(2): 224-229.
13.	National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, et al. Early restrictive or liberal fluid management for sepsis-induced hypotension. N Engl J Med, 2023, 388(6): 499-510.
14.	Crivellari C, Magliocca A, Dulama C, et al. Tipping the balance: early post-resuscitation fluid accumulation and outcome after cardiac arrest. Crit Care, 2025, 29(1): 384.
15.	National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med, 2006, 354(24): 2564-2575.
16.	Schol PB, Terink IM, Lancé MD, et al. Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis. J Clin Anesth, 2016, 35: 26-39.
17.	Fletcher DJ, Boller M. Fluid therapy during cardiopulmonary resuscitation. Front Vet Sci, 2021, 7: 625361.
18.	Lutz J, Levenbrown Y, Hossain MJ, et al. Impact of intravenous fluid administration on cardiac output and oxygenation during cardiopulmonary resuscitation. Intensive Care Med Exp, 2023, 11(1): 13.
19.	Silversides JA, Major E, Ferguson AJ, et al. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med, 2017, 43(2): 155-170.
20.	Kjaergaard J, M?ller JE, Schmidt H, et al. Blood-pressure targets in comatose survivors of cardiac arrest. N Engl J Med, 2022, 387(16): 1456-1466.
21.	Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med, 2004, 350(22): 2247-2256.
22.	Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med, 2012, 367(20): 1901-1911.
23.	Bentzer P, Griesdale DE, Boyd J, et al. Will this hemodynamically unstable patient respond to a bolus of intravenous fluids?. JAMA, 2016, 316(12): 1298-1309.
24.	Biais M, Ehrmann S, Mari A, et al. Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach. Crit Care, 2014, 18(6): 587.
25.	Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest, 2008, 134(1): 172-178.
26.	De Backer D, Vincent JL. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care, 2018, 22(1): 43.
27.	Ismail MT, El-Iraky AA, Ibrahim EEA, et al. Comparison of inferior vena cava collapsibility and central venous pressure in assessing volume status in shocked patients. Afr J Emerg Med, 2022, 12(3): 165-171.
28.	Kalshetty K, Jahan N, Setlur R, et al. Inferior vena cava collapsibility index for the assessment of fluid responsiveness among spontaneously breathing preoperative fasting patients-an observational study. J Mar Med Soc, 2020, 22(2): 151-155.
29.	Królicki T, Molsa M, Tukiendorf A, et al. Superior vena cava collapsibility index as a predictor of fluid responsiveness: a systematic review with meta-analysis. Anaesthesiol Intensive Ther, 2024, 56(3): 169-176.
30.	Toppen W, Aquije Montoya E, Ong S, et al. Passive leg raise: feasibility and safety of the maneuver in patients with undifferentiated shock. J Intensive Care Med, 2020, 35(10): 1123-1128.
31.	Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med, 2016, 42(12): 1935-1947.
32.	Minini A, Abraham P, Malbrain MLNG. Predicting fluid responsiveness with the passive leg raising test: don’t be fooled by intra-abdominal hypertension!. Ann Transl Med, 2020, 8(12): 799.
33.	Takegawa R, Hayashida K, Rolston DM, et al. Near-infrared spectroscopy assessments of regional cerebral oxygen saturation for the prediction of clinical outcomes in patients with cardiac arrest: a review of clinical impact, evolution, and future directions. Front Med (Lausanne), 2020, 7: 587930.
34.	Dhillon GS, Berg MD. Near-infrared spectroscopy in pediatric cardiac arrest: a piece of the clinical picture. Crit Care Med, 2024, 52(5): 856-859.

1. Soar J, B?ttiger BW, Carli P, et al. European Resuscitation Council guidelines 2021: adult advanced life support. Resuscitation, 2021, 161: 115-151.
2. Hirsch KG, Amorim E, Coppler PJ, et al. Part 11: post-cardiac arrest care: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(Suppl 2): S673-S718.
3. Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation, 2008, 118(23): 2452-2483.
4. Jendoubi A, De Roux Q, Lê MP, et al. Fluid therapy during and after cardiopulmonary resuscitation for nontraumatic cardiac arrest: a systematic review of evidence from preclinical and clinical studies. Shock, 2025, 63(3): 363-370.
5. Jentzer JC, Chonde MD, Dezfulian C. Myocardial dysfunction and shock after cardiac arrest. Biomed Res Int, 2015, 2015: 314796.
6. Joffre J, Radermacher P, Kallel H, et al. Vascular leakage during circulatory failure: physiopathology, impact and treatments. Ann Intensive Care, 2025, 15(1): 79.
7. Langeland H, Dam?s JK, Mollnes TE, et al. The inflammatory response is related to circulatory failure after out-of-hospital cardiac arrest: a prospective cohort study. Resuscitation, 2022, 170: 115-125.
8. Kosta S, Dauby PC. Frank-starling mechanism, fluid responsiveness, and length-dependent activation: unravelling the multiscale behaviors with an in silico analysis. PLoS Comput Biol, 2021, 17(10): e1009469.
9. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001, 345(19): 1368-1377.
10. Zhang MQ, Macala KF, Fox-Robichaud A, et al. Sex- and gender-dependent differences in clinical and preclinical sepsis. Shock, 2021, 56(2): 178-187.
11. Renaudier M, Lascarrou JB, Chelly J, et al. Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit. Crit Care, 2025, 29(1): 152.
12. Gul F, Peterson E, Dejoy R, et al. Association between intravenous fluid resuscitation and hospital mortality in post cardiac arrest patients: a retrospective study. Shock, 2021, 55(2): 224-229.
13. National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, et al. Early restrictive or liberal fluid management for sepsis-induced hypotension. N Engl J Med, 2023, 388(6): 499-510.
14. Crivellari C, Magliocca A, Dulama C, et al. Tipping the balance: early post-resuscitation fluid accumulation and outcome after cardiac arrest. Crit Care, 2025, 29(1): 384.
15. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med, 2006, 354(24): 2564-2575.
16. Schol PB, Terink IM, Lancé MD, et al. Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis. J Clin Anesth, 2016, 35: 26-39.
17. Fletcher DJ, Boller M. Fluid therapy during cardiopulmonary resuscitation. Front Vet Sci, 2021, 7: 625361.
18. Lutz J, Levenbrown Y, Hossain MJ, et al. Impact of intravenous fluid administration on cardiac output and oxygenation during cardiopulmonary resuscitation. Intensive Care Med Exp, 2023, 11(1): 13.
19. Silversides JA, Major E, Ferguson AJ, et al. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med, 2017, 43(2): 155-170.
20. Kjaergaard J, M?ller JE, Schmidt H, et al. Blood-pressure targets in comatose survivors of cardiac arrest. N Engl J Med, 2022, 387(16): 1456-1466.
21. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med, 2004, 350(22): 2247-2256.
22. Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med, 2012, 367(20): 1901-1911.
23. Bentzer P, Griesdale DE, Boyd J, et al. Will this hemodynamically unstable patient respond to a bolus of intravenous fluids?. JAMA, 2016, 316(12): 1298-1309.
24. Biais M, Ehrmann S, Mari A, et al. Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach. Crit Care, 2014, 18(6): 587.
25. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest, 2008, 134(1): 172-178.
26. De Backer D, Vincent JL. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care, 2018, 22(1): 43.
27. Ismail MT, El-Iraky AA, Ibrahim EEA, et al. Comparison of inferior vena cava collapsibility and central venous pressure in assessing volume status in shocked patients. Afr J Emerg Med, 2022, 12(3): 165-171.
28. Kalshetty K, Jahan N, Setlur R, et al. Inferior vena cava collapsibility index for the assessment of fluid responsiveness among spontaneously breathing preoperative fasting patients-an observational study. J Mar Med Soc, 2020, 22(2): 151-155.
29. Królicki T, Molsa M, Tukiendorf A, et al. Superior vena cava collapsibility index as a predictor of fluid responsiveness: a systematic review with meta-analysis. Anaesthesiol Intensive Ther, 2024, 56(3): 169-176.
30. Toppen W, Aquije Montoya E, Ong S, et al. Passive leg raise: feasibility and safety of the maneuver in patients with undifferentiated shock. J Intensive Care Med, 2020, 35(10): 1123-1128.
31. Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med, 2016, 42(12): 1935-1947.
32. Minini A, Abraham P, Malbrain MLNG. Predicting fluid responsiveness with the passive leg raising test: don’t be fooled by intra-abdominal hypertension!. Ann Transl Med, 2020, 8(12): 799.
33. Takegawa R, Hayashida K, Rolston DM, et al. Near-infrared spectroscopy assessments of regional cerebral oxygen saturation for the prediction of clinical outcomes in patients with cardiac arrest: a review of clinical impact, evolution, and future directions. Front Med (Lausanne), 2020, 7: 587930.
34. Dhillon GS, Berg MD. Near-infrared spectroscopy in pediatric cardiac arrest: a piece of the clinical picture. Crit Care Med, 2024, 52(5): 856-859.

West China Medical Journal

Fluid management strategies during and after cardiopulmonary resuscitation: evidence trade-offs between restrictive and liberal fluid therapy strategies

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content