CT imaging in idiopathic out-of-hospital cardiac arrest: An assessment of current practice and diagnostic utility

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Idiopathic non-traumatic out-of-hospital cardiac arrest with return of spontaneous circulation (n=156). Intervention: Computed Tomography (CT) imaging vs. No CT imaging. Primary outcome: Diagnostic identification of out-of-hospital cardiac arrest etiology.

Q: What does this research mean for the field?

In patients with idiopathic out-of-hospital cardiac arrest, CT imaging has a limited diagnostic yield for identifying the underlying cause of arrest (4%) but safely detects important secondary pathology in over a third of patients without complications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Isla Harper; Kate Easterford; Matthew James Reed

doi:10.4081/ecj.2022.10669

September 27, 2022Emergency Care JournalOpen Access

CT imaging in idiopathic out-of-hospital cardiac arrest: An assessment of current practice and diagnostic utility

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Key result

CT imaging identifies the underlying cause in ~4% of idiopathic OHCA cases.

n=156

Why the study?

Idiopathic out-of-hospital cardiac arrest requires urgent treatment, and early CT imaging may aid diagnosis. This study sought to determine current CT imaging practice, safety, and diagnostic value in this patient population.

Key Points

To determine current CT imaging practice, safety profile, and diagnostic value in patients presenting with idiopathic non-traumatic out-of-hospital cardiac arrest and return of spontaneous circulation.
Single-centre, retrospective cohort study of patients presenting to the emergency department of the Royal Infirmary of Edinburgh between 1st January 2016 and 31st December 2019.
Included 156 eligible patients with idiopathic non-traumatic out-of-hospital cardiac arrest achieving return of spontaneous circulation, of whom 140 underwent CT imaging.
A total of 195 CT scans were performed across 140 patients, identifying the underlying cause of cardiac arrest in 6 patients (4%), consisting of three haemorrhagic strokes, one ischaemic stroke, one acute coronary syndrome, and one pulmonary embolism.
Important pathology was identified in 68 of 195 scans (35%), mostly secondary to the cardiac arrest itself.
Imaging showed no documented complications, with zero cases of contrast-induced nephropathy or allergic reactions.

Study Design

Type

Cohort (n=156)

Multicenter

No

PICO

P

Population

156 patients (mean age 60 years, 29% female) with idiopathic non-traumatic out-of-hospital cardiac arrest and return of spontaneous circulation presenting to a single emergency department and admitted to the ICU over 4 years.

E

Exposure / Comparator

Computed Tomography (CT) imaging vs No CT imaging

O

Primary Outcome

Diagnostic identification of out-of-hospital cardiac arrest etiology

Limitations

Single-centre retrospective design
Low utilization of whole-body CT (only 5 patients)
Potential unmeasured impact of negative CT scans on clinical management

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Implication

CT may identify actionable findings in idiopathic OHCA; leaves open whether routine use improves outcomes.

Abstract

Idiopathic Out-Of-Hospital Cardiac Arrest (OHCA) requires urgent treatment. Early Computed Tomography (CT) imaging may be useful to aid diagnosis. We aimed to determine current CT imaging practice, safety, and diagnostic value in this patient population. This study was a single-centre, retrospective cohort study of patients presenting to the Emergency Department (ED) of the Royal Infirmary of Edinburgh with idiopathic non-traumatic OHCA and Return Of Spontaneous Circulation (ROSC). Between 1st January 2016 and 31st December 2019, 140 of 156 (90%) eligible patients underwent 195 CT scans identifying the cause of OHCA in 6 (4%). CT head diagnosed one ischaemic and three haemorrhagic strokes, and CT pulmonary angiogram diagnosed one acute coronary syndrome and one pulmonary embolism. CT head (134), CT pulmonary angiogram (25) and CT cervical spine (16) were the commonest scans. 68 of 195 (35%) CT scans showed important pathology, mostly secondary to OHCA. CT imaging was safe with no cases of contrast nephropathy, allergic reaction, or other complications. The diagnostic value of CT imaging in this patient population was limited. However, imaging was a valuable method of identifying other important secondary pathology.

Discussion

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Cite This Study

Harper et al. (2022) conducted a cohort in Idiopathic non-traumatic out-of-hospital cardiac arrest with return of spontaneous circulation (n=156). Computed Tomography (CT) imaging vs. No CT imaging was evaluated on Diagnostic identification of out-of-hospital cardiac arrest etiology. CT imaging identified the underlying cause of idiopathic out-of-hospital cardiac arrest in 4% (6/140) of patients and detected other important pathology in 37% (52/140) with zero complications.

synapsesocial.com/papers/6ae751b556e7bb18546a1537 https://doi.org/10.4081/ecj.2022.10669

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CT imaging in idiopathic out-of-hospital cardiac arrest: An assessment of current practice and diagnostic utility

Key Points

Study Design

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

CT imaging in idiopathic out-of-hospital cardiac arrest: An assessment of current practice and diagnostic utility

Key Points

Study Design

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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