The role of cranial computed tomography in the immediate post-cardiac arrest period

Abstract

Patients who initially survive cardiac arrest are often admitted to an intensive care unit comatose and on mechanical ventilation. It is not clear whether or not a screening cranial computed tomography (CT scan) is necessary in the immediate post-arrest period. We hypothesized that there may be clinically relevant information gleaned from head CT scans obtained early in the post-arrest period that could affect immediate management of these patients, even when non-neurologic causes of cardiac arrest are suspected. A retrospective data analysis was conducted of all survivors (age >18 years) of non-traumatic out-of-hospital cardiac arrest (OHCA) who underwent non-contrast head CT (NCHCT) within the first 24 h of admission. A total of 84 patients were identified and 51 (60.7%) met the inclusion criteria. As much as 45 (88.2%) patients in the total cohort had an NCHCT negative for ICH or herniation; of this group, 39 (76.5%) had a normal NCHCT, while six (11.8%, 95% CI: 5.1-23.8%) demonstrated varying degrees of cerebral edema or loss of gray-white matter distinction consistent with anoxic brain injury, but without herniation. Six patients (11.8%, 95% CI: 5.1-23.8%) exhibited findings consistent with either an ICH (with or without herniation) or herniation without an ICH. Four (7.8%) of these patients had an ICH without herniation, one had an acute SAH with edema and herniation, and one had frank herniation due to massive cerebral edema. The overall incidence of any kind of intracranial hemorrhage in our cohort was 9.8% (95% CI: 3.8-21.4%). In this cohort of post-cardiac arrest patients who underwent cranial computed tomography, 11.8% of patients had clinically significant abnormalities identified. The exact role of neuroimaging in this population is still in evolution, and further prospective evaluation is warranted.

Out-of-Hospital Cardiac Arrest From Brain Cause

“…But the adequate identification of patients requiring brain CT scan is a challenge, and studies converge toward a poor utility rate of this investigation. We recently reported that only 13% of brain CT scan identified a lesion deemed responsible for OHCA, a finding consistent with previous studies reporting rates lower than 20% (20,33). However, faced with an abnormal CT scan, medical management was significantly altered (33).…”

Use of early head CT following out-of-hospital cardiopulmonary arrest

“…3–5 Furthermore, other clinically significant abnormalities can be found which result in changes in clinical management up to 39% of the time. 6,7 In this study we aim to characterize the use of early HCT in a large academic center and its impact on post-resuscitation management and prognosis.…”

Early Head CT Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest*

“…None of these modalities is 100% sensitive and specific for neurologic outcome in the first 24 hours post–cardiac arrest. Early head CT is often obtained following successful initial resuscitation to diagnose potential cardiac arrest etiology (e.g., intracranial hemorrhage, hydrocephalus, trauma, and tumor) and to assess the presence and severity of post–cardiac arrest cerebral ischemia and edema (6, 7). Early CT loss of gray-white matter (GWM) differentiation is associated with worse survival and neurologic outcomes following adult OHCA (8–10).…”