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Computed-Tomography as First-line Diagnostic Procedure in Patients With Out-of-Hospital Cardiac Arrest
John Adel1, Muharrem Akin1, Vera Garcheva1
1Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany.
Insights
Computed tomography (CT) after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) reveals numerous life-threatening causes and consequences. Early CT imaging aids in identifying critical pathologies, potentially improving patient prognosis.
Area of Science:
- Emergency Medicine
- Radiology
- Cardiology
Background:
- Mortality remains high after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC).
- Coronary angiography is crucial for suspected coronary causes, but other life-threatening conditions and cardiopulmonary resuscitation (CPR) injuries may be missed.
- Computed tomography (CT) can detect these alternative causes and complications.
Purpose of the Study:
- To evaluate the utility of early CT scanning in identifying causes and consequences of OHCA with ROSC.
- To assess the impact of CT findings on post-arrest care and prognosis.
Main Methods:
- A retrospective analysis of 225 successfully resuscitated OHCA patients who underwent rapid CT scans.
- CT scans were performed as a standard of care prior to intensive care unit admission.
- Data on patient demographics, arrest characteristics, and CT findings were analyzed.
Main Results:
- CT identified critical pathologies such as intracranial bleeding, aortic dissection, pulmonary embolism, pericardial tamponade, and tension pneumothorax.
- CPR-related injuries including aspiration, rib fractures, sternal fractures, spinal fractures, hepatic bleeding, and intra-abdominal air were frequently observed.
- No significant differences in CT pathologies were found between patients with or without ST-segment elevations on initial ECG.
Conclusions:
- Early CT scanning following OHCA with ROSC uncovers a high number of critical findings.
- These findings, including both causes of arrest and CPR complications, are frequently life-threatening.
- CT imaging can significantly contribute to improving post-arrest care and patient prognosis.
Background:
Mortality after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) remains high despite numerous efforts to improve outcome. For patients with suspected coronary cause of arrest, coronary angiography is crucial. However, there are other causes and potentially life-threatening injuries related to cardiopulmonary resuscitation (CPR), which can be detected by routine computed tomography (CT).
Materials And Methods:
At Hannover Medical School, rapid coronary angiography and CT are performed in successfully resuscitated OHCA patients as a standard of care prior to admission to intensive care. We analyzed all patients who received CT following OHCA with ROSC over a three-year period.
Results:
There were 225 consecutive patients with return of spontaneous circulation following out-of-hospital cardiac arrest. Mean age was 64 ± 13 years, 75% were male. Of them, 174 (77%) had witnessed arrest, 145 (64%) received bystander CPR, and 123 (55%) had a primary shockable rhythm. Mean time to ROSC was 24 ± 20 min. There were no significant differences in CT pathologies in patients with or without ST-segment elevations in the initial ECG. Critical CT findings qualifying as a potential cause for cardiac arrest were intracranial bleeding (N = 6), aortic dissection (N = 5), pulmonary embolism (N = 17), pericardial tamponade (N = 3), and tension pneumothorax (N = 11). Other pathologies were regarded as consequences of CPR and relevant for further treatment: aspiration (N = 62), rib fractures (N = 161), sternal fractures (N = 50), spinal fractures (N = 11), hepatic bleeding (N = 12), and intra-abdominal air (N = 3).
Conclusion:
Early CT fallowing OHCA uncovers a high number of causes and consequences of OHCA and CPR. Those are relevant for post-arrest care and are frequently life-threatening, suggesting that CT can contribute to improving prognosis following OHCA.
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