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

Abstract

Aim Neurological emergencies can lead to cardiac arrest, and post-arrest patients can develop life-threatening neurological abnormalities. This study aims to estimate and characterize the use of early head CT, and its potential impact on post-resuscitation management. Methods This retrospective study analyzed 213 adults suffered an out-of-hospital cardiac arrest (OHCA) and survived for at least 24 hours. Demographics were collected and arrest-related variables were documented. Timing of HCT was recorded and if abnormalities were found on HCT within 24 hours of resuscitation, any resulting changes in management were recorded. Outcome was measured by cerebral performance category at discharge. Results Only 54% of patients who survived OHCA underwent HCT in the first 24 hours after resuscitation. Patients who underwent HCT were healthier and had better pre-arrest functional status and shorter duration of their arrest. Acute abnormalities were found on 38% of HCT and 34% of these abnormal scans resulted in management changes. Conclusions Early HCT is not done consistently performed after outside hospital cardiac arrest and may be heavily influenced by a patient’s premorbid status and arrest-related variables. Early Head CT can demonstrate acute abnormalities that can result in significant changes in patient management.

Neurological prognostication tools in out‐of‐hospital cardiac arrest patients in Danish intensive care units from 2005 to 2013

“…Others have found inconsistent use of acute head CT scans that might indicate physician bias toward using this procedure more often in patients with fewer comorbidities and good cerebral function prior to OHCA . We did not find differences in use of procedures related to age, sex, income, or education; however, we did find that patients with shockable rhythm and arrest in public less often had neurological prognostication performed, probably indicating that patients with a favorable pre‐hospital profile carry a better prognosis, and thus have a lower need of neurological prognostication.…”

Computed-Tomography as First-line Diagnostic Procedure in Patients With Out-of-Hospital Cardiac Arrest

“…In this context, CT performed on admission provides essential information by ruling out immediately compromising conditions. Especially when considering the neurologic status after prolonged cardiopulmonary arrest in comatose patients, CT imaging helps to detect significant and irreversible pathologies on admission and may guide prognostication (28,38). Therefore, CT imaging to detect brain injury and predict neurological outcome is, together with magnetic resonance imaging, the most studied neuroimaging modality (25).…”

Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest

“…Following CA, cerebral edema occurs as early as the first 24 h, with CT imaging demonstrating diffuse loss of gray-white differentiation in up to 12% of scans performed and global cerebral edema in as many as 6% ( 120 ). ICP monitoring is frequently used when cerebral edema is diagnosed in brain injured patients, including those with traumatic brain injury, intracerebral hemorrhage, or subarachnoid hemorrhage.…”