IV Fluids in Cardiac Arrest

Question#: 659

Question:

Is there any direction for IV bolus in medical cardiac arrest for PCP IV autonomous? The trauma TOR directive states we can give a bolus as long as it does not delay transport or other treatment. Does the same apply for medical arrest?

Answer:

There is evidence to support fluid therapy in traumatic arrests (think Hs&Ts); however, there is little to no evidence to suggest fluid therapy is beneficial in cardiac arrests.

The prehospital cardiac arrest literature  suggests that there are two interventions that continually have been shown to have positive impacts: high-quality 'non interrupted' CPR, and early defibrillation. Ultimately our treatments should be focused on optimizing these two interventions.

Given that there are no cardiac arrest specific interventions (i.e. ACLS medications) within the PCP scope, there is no role for initiation an IV in this cohort of patients. As you’re aware, inserting an IV takes several steps and resources, which can pull you away from the “basics”. This is very much a population that can benefit from “doing the basics well”. Drug administration is of secondary importance, and few drugs used in the treatment of cardiac arrest are supported by strong evidence. 

In summary, focusing on high quality 'non-interrupted' CPR and early defibrillation are key to cardiac arrest survival and should be the focus on your interventions.

References:

https://www.resuscitationjournal.com/article/S0300-9572(22)00684-0/fulltext#articleInformation

https://www.ahajournals.org/doi/10.1161/CIR.0000000000000916