Due to its characteristics, fresh fish is a highly perishable food with a very short shelf-life under refrigeration. Several methods have been introduced to slow down its deterioration, such as by means of oxygen depletion of the food package (vacuum packaging), or by changing the natural atmosphere that is in contact with the fresh fish (modified atmosphere packaging), or by the use of chemicals generally recognized as safe: such compounds can be directly applied (by dipping or spraying) or incorporated into packaging materials and slowly migrate to the product, exerting a hurdle effect against microbial development and lipid oxidation (active packaging). This review aims to cover the most recent advances in chemical-based approaches for fresh fish preservation, applied either singly or in combination. Vacuum packaging, modified atmosphere, and active packaging preservation methodologies are presented, along with the inclusion of chemical additives, such as organic acids and natural extracts, and their combination with icing systems. Advantages and disadvantages of these methodologies and their impact on fresh fish quality and shelf-life are discussed, reaching the conclusion that both are positively influenced overall. Indeed, the contribution of chemical-based strategies for fresh fish preservation is undeniable, and is expected to be a research topic of increasing interest in the future.