Diagnostic accuracy of early computed tomographic coronary angiography to detect coronary artery disease after out-of-hospital circulatory arrest

Branch, Kelley; Hira, Ravi S.; Brusen, Robin; Maynard, Charles; Kudenchuk, Peter J.; Petek, Bradley J.; Strote, Jared; Sayre, Michael R.; Gatewood, Medley; Carlbom, David; Counts, Catherine R.; Probstfield, Jeffrey L.; Gunn, Martin L.

doi:10.1016/j.resuscitation.2020.04.033

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…An acute coronary syndrome patient was missed due to an uninterpretable thoracic CT scan, and the one missed patient with cardiomyopathy had normal left ventricular size and did not have the entire cardiac cycle for analysis. A previously published subset of 28 of our patients demonstrated a high sensitivity (85%) and specificity (88%) for SDCT to identify obstructive coronary artery disease compared to ICA 10 . These data suggest incremental benefit of cardiac analysis for that could augment or replace early echocardiography or ICA for certain patients resuscitated after OHCA.…”

Section: Discussionsupporting

confidence: 60%

“…CT scanning can evaluate head and neck, thorax (including the lungs and vascular system), heart (including coronary arteries), and abdominal organs and structures 8,9 . Current guidelines recommend use of coronary CT angiography (CCTA) in patients resuscitated from OHCA, 3‐5 although CCTA data in this population are scarce 10,11 . If CT scanning were to extend from head to pelvis, up to 75% to 86% of potential anatomic diagnoses could potentially be ascertained based on causes of death identified on autopsy 12 .…”

Section: Introductionmentioning

confidence: 99%

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Early head‐to‐pelvis computed tomography in out‐of‐hospital circulatory arrest without obvious etiology

Branch

Strote

Gunn

et al. 2021

Academic Emergency Medicine

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Objectives Patients resuscitated from an out‐of‐hospital circulatory arrest (OHCA) commonly present without an obvious etiology. We assessed the diagnostic capability and safety of early head‐to‐pelvis computed tomography (CT) imaging in such patients. Methods From November 2015 to February 2018, we enrolled 104 patients resuscitated from OHCA without obvious cause (idiopathic OHCA) to an early sudden‐death CT (SDCT) scan protocol within 6 h of hospital arrival. The SDCT protocol included a noncontrast CT head, an electrocardiogram‐gated cardiac and thoracic CT angiogram, and a nongated venous‐phase abdominopelvic CT angiogram. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate SDCT were excluded. Cardiac CT analyses were blinded, but other SDCT findings were clinically available. Primary endpoints were the number of OHCA causes identified by SDCT compared to the adjudicated cause and critical diagnoses identified by SDCT, including resuscitation complications. Safety endpoints were acute kidney injury (AKI) and inappropriate treatments based on SDCT findings. Acute coronary syndrome was the presumed etiology if any major coronary artery had a >50% stenosis without another OHCA cause. Results SDCT scans occurred within 1.9 ± 1.0 h of hospital arrival and identified 39% (41/104) of all OHCA causes and 95% (39/41) of causes potentially identifiable by SDCT. Critical findings were identified by SDCT in 98% (43/44) of patients that included potentially life‐threatening resuscitation complications of liver or spleen laceration (n = 6); pneumothorax or thoracic organ laceration (n = 8); and mediastinal, pericardial, or vascular hemorrhage (n = 3). SDCT exclusively identified 13 (13%) OHCA causes that would otherwise not be identified without SDCT imaging. No inappropriate treatments resulted from SDCT findings. AKI was common (28%) but only one (1%) patient required new dialysis. Conclusions This observational cohort study suggests that early SDCT scanning is safe, can expedite the diagnosis of potential causes, and can meaningfully change clinical management after idiopathic OHCA.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Early head‐to‐pelvis computed tomography in out‐of‐hospital circulatory arrest without obvious etiology

Branch

Strote

Gunn

et al. 2021

Academic Emergency Medicine

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“…The full methods of the study have been previously described (National Clinical Trial number 03111043). 4 , 5 Briefly, CT‐FIRST (CT Feasibility In Resuscitated Patients for Sudden Death Triage) was a prospective, observational study of patients resuscitated after an OHCA event but without obvious cause for the OHCA event (termed idiopathic OHCA ). The study was designed to evaluate the incremental diagnostic capability and safety of early (<6 hours from hospital arrival) head‐to‐pelvis SDCT in addition to standard care.…”

Section: Methodsmentioning

confidence: 99%

“…As previously described, all SDCT data, except for coronary imaging data, were read by an attending radiologist and were released to treating providers in real time. 4 , 5 These data included resuscitation injuries. For the purpose of this research analysis, the SDCT studies were independently reviewed by 2 board‐certified radiologists (M.L.G.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Patterns of Resuscitation‐Associated Injury Detected by Head‐to‐Pelvis Computed Tomography After Successful Out‐of‐Hospital Cardiac Arrest Resuscitation

Karatasakis

Sarıkaya

Liu

et al. 2022

JAHA

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Background Patients resuscitated from out‐of‐hospital circulatory arrest (OHCA) frequently have cardiopulmonary resuscitation injuries identifiable by computed tomography, although the prevalence, types of injury, and effects on clinical outcomes are poorly characterized. Methods and Results We assessed the prevalence of resuscitation‐associated injuries in a prospective, observational study of a head‐to‐pelvis sudden‐death computed tomography scan within 6 hours of successful OHCA resuscitation. Primary outcomes included total injuries and time‐critical injuries (such as organ laceration). Exploratory outcomes were injury associations with mechanical cardiopulmonary resuscitation and survival to discharge. Among 104 patients with OHCA (age 56±15 years, 30% women), 58% had bystander cardiopulmonary resuscitation, and total cardiopulmonary resuscitation time was 15±11 minutes. The prevalence of resuscitation‐associated injury was high (81%), including 15 patients (14%) with time‐critical findings. Patients with resuscitation injury were older (58±15 versus 46±13 years; P <0.001), but had otherwise similar baseline characteristics and survival compared with those without. Mechanical chest compression systems (27%) had more frequent sternal fractures (36% versus 12%; P =0.009), including displaced fractures (18% versus 1%; P =0.005), but no difference in survival (46% versus 41%; P =0.66). Conclusions In patients resuscitated from OHCA, head‐to‐pelvis sudden‐death computed tomography identified resuscitation injuries in most patients, with nearly 1 in 7 with time‐critical complications, and one‐half with extensive rib‐cage injuries. These data suggest that sudden‐death computed tomography may have additional diagnostic utility and treatment implications beyond evaluating causes of OHCA. These important findings need to also be taken in context of the certain fatal outcome without resuscitation efforts. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03111043.

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“…24 Coronary computed tomography angiography is also an alternative modality to define coronary anatomy and substrate, with a recent study demonstrating robust sensitivity and specificity for the detection of coronary stenoses. 25 Contemporary rates of coronary angiography in the United States in those hospitalized after VT/VF OHCA range from 87% in those with STEMI to 34% in those without. 26 For patients without STEMI, the survival implications of potential underutilization of coronary angiography in survivors of VT/VF OHCA remains unknown.…”

Section: Diagnostic Evaluation In Secondary Preventionmentioning

confidence: 99%

Secondary prevention of sudden cardiac death

Chatterjee

Rea

2020

Heart Rhythm O2

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The prevention and treatment of sudden cardiac death (SCD) remains a significant public health challenge. For patients with a history of sudden death attributable to ventricular arrhythmia, implantable cardioverter-defibrillator (ICD) therapy is a mainstay of treatment, although these patients remain at high risk for recurrent ventricular arrhythmia and defibrillator therapies. In this review, we summarize landmark clinical trials evaluating the efficacy of ICD therapy in secondary prevention patients, review clinical outcomes including mode of death in survivors of SCD, and highlight the role for systematic diagnostic evaluation. We additionally discuss the invasive electrophysiological management of these patients, including ICD selection and programming as well as the role and timing of antiarrhythmic drug therapy and catheter ablation. Finally, we frame future challenges and needs to advance the care for secondary prevention patients.

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Diagnostic accuracy of early computed tomographic coronary angiography to detect coronary artery disease after out-of-hospital circulatory arrest

Cited by 12 publications

References 17 publications

Early head‐to‐pelvis computed tomography in out‐of‐hospital circulatory arrest without obvious etiology

Early head‐to‐pelvis computed tomography in out‐of‐hospital circulatory arrest without obvious etiology

Prevalence and Patterns of Resuscitation‐Associated Injury Detected by Head‐to‐Pelvis Computed Tomography After Successful Out‐of‐Hospital Cardiac Arrest Resuscitation

Secondary prevention of sudden cardiac death

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