Effects of peri-arrest hypertonic/hyperoncotic fluid treatment on clinical outcomes in non-trauma-related resuscitation - A scoping review.
Resuscitation Plus · 2025-11-20 · Scoping review
Abstract
AIM: This scoping review aimed to summarize existing evidence on the administration of hypertonic and hyperoncotic (HTF/HOF) fluids during cardiopulmonary resuscitation (CPR) in both human and animal studies. Further, we sought to provide guidance for future research and potential clinical implementation strategies. METHODS: We searched Medline, EMBASE, Cochrane, Web of Science, Scopus and Clinicaltrials.gov from inception to June 11th, 2025, for comparative studies using HTF/HOF in non-trauma-related peri-arrest settings in animal models and humans. Studies were selected using a PICOST format. Studies were assessed on their risk of bias. Results were synthesized narratively and presented using descriptive statistics. No meta-analysis was performed. RESULTS: We included 21 animal and four human studies. Animal studies showed high heterogeneity in species, cardiac arrest models, timing and composition of HTF/HOF. Most of them found improved neurological outcomes compared to normal saline. In the human studies (overall sample size 932), patients were either treated with a combination of hypertonic saline and hydroxyethyl starch (HHS) or with hypertonic saline alone (HS). Time points of fluid administration and assessed outcome parameters differed substantially. Overall, human studies indicated neutral to favorable effects, supporting the potential value of HTF/HOF treatment. CONCLUSIONS: Studies analyzing the effects of HTF/HOF in peri-arrest settings in animals and in humans suggest potential benefit on survival and neurological outcomes. Findings are limited by substantial heterogeneity in study designs, timing and outcome measures. It therefore appears necessary to conduct more rigorous clinical trials with standardized endpoints to further explore the potential of peri-arrest HTF/HOF treatment.
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Tags
Crystalloids · Fluids & blood · Hypertonic saline
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