Fluids for cooling post cardiac arrest

Large volume cold fluid resuscitation after return of spontaneous circulation can contribute to effective cooling but does it impair cardiac or respiratory function? A retrospective review of 52 resuscitated cardiac arrest patients suggests that the infusion of large volumes of cold fluid does not cause a further significant reduction in  respiratory function beyond that normally seen after cardiac arrest despite significantly reduced LV function.

Effects of large volume, ice-cold intravenous fluid infusion on respiratory function in cardiac arrest survivors
Resuscitation. 2009 Nov;80(11):1223-8

In the same issue of Resuscitation, a prospective study of cardiac arrest survivors in positive fluid balance from cold fluid cooling showed frequent evidence of hypovolaemia as determined by serial ultrasound assessment.

An accompanying editorial suggests this may be due to the systemic inflammatory response syndrome that follows successful cardiac arrest resuscitation; large volumes are tolerated well and myocardial dysfunction should not lead to restriction of fluids after cardiac arrest.

Assessment of intravascular volume by transthoracic echocardiography during therapeutic hypothermia and rewarming in cardiac arrest survivors
Resuscitation. 2009 Nov;80(11):1234-9