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Branch KR, Gatewood MO, Kudenchuk P, Lee JC, Strote J, Petek BJ, De Boer I, Carlbom D, Shuman WP, Counts CR, Sayre MR, Gunn M. P6155Early computed tomographic evaluation for out-of-hospital cardiac arrest survivors: the CT-FIRST trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients surviving an out-of-hospital cardiac arrest (OHCA) commonly present without an obvious etiology, but computed tomography (CT) can provide rapid, comprehensive anatomic evaluation of potential OHCA causes.
Purpose
To assess the diagnostic capabilities of whole body CT imaging in OHCA survivors.
Methods
From 11/2015 to 2/2018, the CT-FIRST (CT Feasibility In Resuscitated patient for Sudden death Triage) protocol enrolled 104 OHCA survivors without obvious OHCA cause to an early (<6 hours from hospital arrival) dual source Sudden Death CT (SDCT) scan protocol that included a non-contrast head, ECG-gated cardiac/thoracic angiography, and non-gated venous phase abdominal CT's. Cardiac CT analysis was blinded, but other SDCT findings were clinically available. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate CT were excluded. Primary endpoints were SDCT diagnosis compared to OHCA causes from adjudicated record review, and any significantly altered therapy based on SDCT. Acute coronary syndrome by SDCT was conservatively assumed if >50% stenosis was identified in major coronary artery(ies).
Results
SDCT scans identified 39% (41/104) of all OHCA causes and 95% (41/43) of causes potentially identifiable with SDCT (Table). No inappropriate treatments resulted from SDCT findings. SDCT changed or expedited treatments in 21/23 (95%) patients, including antibiotics, anticoagulants, and invasive evaluations or treatments. SDCT found or confirmed resuscitation complications including liver/spleen laceration (n=5), pneumothorax (n=7), and hemopericardium (n=1).
N=104 OHCA Cause SDCT Diagnosis of OHCA Cause N (%) N (%) Acute coronary syndrome 13 (13%) 13 (100%) Cardiomyopathy 8 (8%) 7 (88%) Pneumonia 11 (11%) 11 (100%) Hemorrhagic stroke 3 (3%) 3 (100%) Pulmonary embolism 4 (3%) 4 (100%) Perforated viscus 2 (2%) 2 (100%) Gut necrosis 1 (1%) 1 (100%) Pulmonary hemorrhage 1 (1%) 1 (100%) Substance use 22 (21%) 0 (0%) Unknown 7 (7%) 0 (0%) Other 32 (31%) 0 (0%)
Conclusion
This pilot study suggests the SDCT protocol has considerable promise to diagnose OHCA causes and complications of resuscitation, as well as change clinical treatment.
Acknowledgement/Funding
Medic One Foundation
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Affiliation(s)
- K R Branch
- University of Washington, Cardiology, Seattle, United States of America
| | - M O Gatewood
- University of Washington, Emergency Medicine, Seattle, United States of America
| | - P Kudenchuk
- University of Washington, Cardiology, Seattle, United States of America
| | - J C Lee
- Henry Ford Hospital, Cardiology, Detroit, United States of America
| | - J Strote
- University of Washington, Emergency Medicine, Seattle, United States of America
| | - B J Petek
- Massachusetts General Hospital, Internal Medicine, Boston, United States of America
| | - I De Boer
- University of Washington, Cardiology, Seattle, United States of America
| | - D Carlbom
- University of Washington, Cardiology, Seattle, United States of America
| | - W P Shuman
- University of Washington, Radiology, Seattle, United States of America
| | - C R Counts
- Harborview Medical Center, Medic One, Seattle, United States of America
| | - M R Sayre
- Harborview Medical Center, Medic One, Seattle, United States of America
| | - M Gunn
- Harborview Medical Center, Radiology, Seattle, United States of America
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