Abstract 101: Early Post-Resuscitative Care of Adult, Non-Traumatic Cardiopulmonary Arrests is Rarely Affected by Routine Head Computed Tomography
Background: The role of early head CT in the management of non-traumatic out-of-hospital cardiopulmonary arrests (NT-OHCA) is unclear.
Objectives: To evaluate the diagnostic value of early head CT and its potential drawbacks in NT-OHCA.
Methods: Between June 2007 – July 2009 all NT-OHCA patients aged >18, transported to our hospital, an urban, level one trauma teaching hospital were included. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes. The study population was grouped into those who did and did not have an early CT. The data was analyzed in relation to initial rhythm, outcomes and changes or delay in treatment.
Results: In total 201 NT-OHCA were transported to our ED during the study period; 125 (62%) were successfully resuscitated and admitted to the hospital, of which 86 (69%) had CT. Initial rhythm in those with CT was VT/VF in 33/86 (38%), PEA/asystole 48/86 (56%), and unspecified 5/86 (6%). Evidence of cerebral edema was found more commonly in patients with PEA/asystole 20/48 (42%) vs. VT/VF 4/33 (12%), p=0.006. In-hospital mortality for patients with cerebral edema was 20/20 (100%) in patients with PEA/asystole and 1/4 (25%) in VT/VF, p=0.002. Fifty-five of 125 (41 VT/VF, 11 PEA/asystole and 3 unspecified) resuscitated patients survived to discharge. CT detected intracranial hemorrhages in 2/86 (2%) of patients. Significant changes in clinical management as a direct result of head CT were uncommon; occurring in 5/86 (6%) resuscitated NT-OHCA patients. Fourteen (16%) of the 86 patients who had CT also had immediate cardiac catheterization for acute ischemic changes; 7 of which had primary percutaneous coronary intervention (PCI). Door to balloon time (DBT) was 96 minutes for 7 patients with ST elevation myocardial infarctions (STEMI) who had CT prior to PCI vs. 75 minutes for 11 patients who did not have CT, p=0.058.
Conclusions: Head CT is common in NT-OHCA. Cerebral edema is more common in patients presenting with an initial rhythm of PEA/asystole than in VT/VF and is associated with higher mortality. Management is rarely affected by routine use of early head CT. In those who required urgent PCI, CT was associated with a (non-statistically significant) 21 minute longer mean DBT.
- © 2010 by American Heart Association, Inc.