Author: Joshua Ruff, MD – PGY2
Go ahead, scan them head to toe.
Background
- 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?
Design
- 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
Results
- 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.
Reference
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.