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A recent prospective observational study examined the diagnostic usefulness of head-to-pelvis sudden death computed tomography (SDCT) in 104 patients with ROSC and unclear OHCA etiology.
- Obtained within 6 hours of hospital arrival
- Noncontrast head CT + ECG-gated chest CTA with abbreviated coronary imaging + contrasted CT of the abdomen to just below the pelvis.
Diagnostic performance:
- Detected 95% of OHCA etiologies diagnosable by CT
- Detected 98% of time-critical diagnoses requiring emergent intervention (including complications of resuscitation)
- The sole reason for diagnosis of OHCA etiology in 13%
Safety:
- 28% of patients with elevated creatinine at 48h (down from 55% at presentation; study excluded GFR < 30ml/min unless treating provider felt the data was needed for care)
- 1% (1 patient) required RRT
- No false positives noted, no allergic contrast reactions, 1 contrast IV extravasation
Bottom Line: For OHCA without clear etiology, SDCT explicitly including a thoracic CTA may have diagnostic benefit over standard care alone with the added benefit of identification of resuscitation complications.
References
Branch KRH, Strote J, Gunn M, et al. 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.