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.
The American Heart Association published the “2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care” in the journal Circulation in October 2025. The new guideline integrates the previously separate adult survival chains for different scenarios and populations into a unified “six-link survival chain” and provides updates and recommendations for multiple key components. Key updates emphasize the following contents: in basic life support, optimization of rescuers’ and patients’ positions, compression strategies for obese or prone patients, systematic management procedures for foreign-body airway obstruction, and details of automated external defibrillator application; in advanced life support, strengthening the core role of epinephrine and standardizing the use of vasoactive agents; updated resuscitation strategies for special situations (such as exposure to highly pathogenic respiratory pathogens and volatile hydrocarbon poisoning); in post-cardiac arrest care, further updates to respiratory and circulatory support, targeted temperature management, and neurological prognosis assessment; and recommendations at the system of care level, including public access to naloxone, video-based dispatch response, and the establishment of resuscitation centers. This article interprets the core recommendations of the guideline to offer references for clinical practice and education.