Author: Joshua Ruff, MD – PGY2

Go ahead, scan them head to toe.


  • The CT scanner: aka ‘donut of truth’ aka ‘answer box’
    • The stigma of over-scanning is real
    • We are taught to be thoughtful and judicious with diagnostics
    • CT scans are expensive, resource heavy
    • Risks: contrast nephropathy, radiation exposure, etc.
  • The EM physician: a resuscitation specialist
    • But after ROSC, the job is not over
    • Evaluation for etiology begins
  • Limited available history, unreliable physical exam (see: intubated, sedated)

Study Question

Can an early head-to-pelvis CT scan safely assist in determining etiology of cardiac arrest in following ROSC?


  • Prospective observational cohort study, 104 subjects from large academic ED
  • Inclusion: Out of hospital arrest, unknown etiology, obtained ROSC in ED
  • Exclusion: required emergent cardiac cath, hemodynamically unstable for CT
  • Patients underwent CT Head non-con, CT Angiogram Chest, CT A/P with contrast


  • Positive outcomes
    • In 13% of cases, determined cause of arrest that would not have been identified without CT
    • Identified 39% of all causes of OHCA
    • Identified 95% of all causes potentially identifiable by CT
  • Negative outcomes
    • 28% of patients developed acute kidney injury (AKI)
    • Only 1 patient required initiation of dialysis
  • Limitation
    • No control group for AKI
    • Unclear causality, as cardiac arrest itself is a risk factor for renal injury

Take Away
There is no shame in pan-scanning your undifferentiated post-ROSC patient. It is safe, effective, and (perhaps) the new standard of care.

Early head-to-pelvis computed tomography in out-of-hospital circulatory arrest without obvious etiology. Acad Emerg Med. 2021 Apr;28(4):394-403. doi: 10.1111/acem.14228. Epub 2021 Mar 24.

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