Computed tomography assessment after out-of-hospital cardiac arrest resuscitation

The present study aims to assess the incidence of causes of cardiac arrest and sequelae after resuscitation from OHCA (out-of-hospital cardiac arrest) identified on early, post-arrest Computed Tomography (CT).

This is an observational, registry study of adult OHCA patients admitted to three hospitals at the University of Pennsylvania Health System who achieved sustained return of spontaneous circulation between January 2019 and October 2020. Data collected encompassed demographics, arrest characteristics, basic metabolic profiles, CT imaging data, and clinical care notes. Primary outcome is survival to hospital discharge and secondary outcomes included neurologic outcome, CT findings and interventions, and IV contrast and kidney injury rates.

Out of 161 patients, 117 received at least one CT in the ED after return of spontaneous circulation. The most common pathologies identified by post-arrest CT scans include cerebral oedema (30/117); pulmonary embolism (8/87); sternal fractures (9/87); pulmonary infiltrates (69/87) that included aspiration, pneumonia, or pneumonitis; deep venous thrombosis (4/64); pulmonary contusions (4/87); hematomas (2/87); flail chest (1/87).

Early CT imaging after ROSC from OHCA regularly identified potential causes of cardiac arrest and important sequelae of resuscitation efforts. Implementing larger scale prospective studies comparing such protocols and standard-of-care is important to determine impact on OHCA outcomes.