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Fluid balance during acute phase extracorporeal cardiopulmonary resuscitation and outcomes in OHCA patients: a retrospective multicenter cohort study

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Abstract

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.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

Abbreviations

OHCA:

Out-of-hospital cardiac arrest

CPR:

Cardiopulmonary resuscitation

ECPR:

Extracorporeal cardiopulmonary resuscitation

ROSC:

Return of spontaneous circulation

ECMO:

Extracorporeal membrane oxygenation

TTM:

Targeted temperature management

CPC:

Cerebral performance category

AKI:

Acute kidney injury

RRT:

Renal replacement therapy

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Acknowledgements

We thank all the members of the SAVE-J II study group who participated in this study (refer to Supplementary Information).

Author information

Author notes

  1. Takuya Taira and Akihiko Inoue contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-Ku, Kobe, Hyogo, 651-0073, Japan

    Takuya Taira, Akihiko Inoue, Masafumi Suga, Takeshi Nishimura, Shinichi Ijuin & Satoshi Ishihara

  2. Faculty of Medicine, Graduate School of Medicine, Kagawa University, Takamatsu, Kagawa, Japan

    Takuya Taira & Yasuhiro Kuroda

  3. Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan

    Hiroshi Okamoto & Toru Hifumi

  4. Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan

    Kunihiko Maekawa

  5. Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan

    Tetsuya Sakamoto

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  1. Takuya Taira
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Consortia

The SAVE-J II study group

Corresponding author

Correspondence to Akihiko Inoue.

Ethics declarations

Ethics approval

The SAVE-J II study is registered at the University Hospital Medical Information Network Clinical Trials Registry and the Japanese Clinical Trial Registry (registration number: UMIN000036490). This study was approved by the institutional review board (IRB) of Kagawa University on October 25, 2018 (approval number:2018–110), as well as by each participating institution. In addition, the IRB of Hyogo Emergency Medical Center (Kobe, Japan) approved the present secondary analysis on October 19, 2022, according to the IRB ethical standards for human experimentation and the Helsinki Declaration of 1975 (approval number: 2022007).

Consent to participate

The local committee waived the requirement for patient consent owing to the retrospective nature of the study.

Conflict of interest

The authors declare no competing interests.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 495 KB)

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Taira, T., Inoue, A., Okamoto, H. et al. Fluid balance during acute phase extracorporeal cardiopulmonary resuscitation and outcomes in OHCA patients: a retrospective multicenter cohort study. Clin Res Cardiol (2024). https://doi.org/10.1007/s00392-024-02444-z

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