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Early computed tomographic evaluation for out-of-hospital cardiac arrest survivors: The CT-FIRST trial

Session Poster Session 7

Speaker Associate Professor Kelley Branch

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Computed Tomography
  • Session type : Poster Session

Authors : K R Branch (Seattle,US), MO Gatewood (Seattle,US), P Kudenchuk (Seattle,US), JC Lee (Detroit,US), J Strote (Seattle,US), BJ Petek (Boston,US), I De Boer (Seattle,US), D Carlbom (Seattle,US), WP Shuman (Seattle,US), CR Counts (Seattle,US), MR Sayre (Seattle,US), M Gunn (Seattle,US)

Authors:
K R Branch1 , MO Gatewood2 , P Kudenchuk1 , JC Lee3 , J Strote2 , BJ Petek4 , I De Boer1 , D Carlbom1 , WP Shuman5 , CR Counts6 , MR Sayre6 , M Gunn7 , 1University of Washington, Cardiology - Seattle - United States of America , 2University of Washington, Emergency Medicine - Seattle - United States of America , 3Henry Ford Hospital, Cardiology - Detroit - United States of America , 4Massachusetts General Hospital, Internal Medicine - Boston - United States of America , 5University of Washington, Radiology - Seattle - United States of America , 6Harborview Medical Center, Medic One - Seattle - United States of America , 7Harborview Medical Center, Radiology - Seattle - United States of America ,

Citation:

Background: Patients surviving an out-of-hospital cardiac arrest (OHCA) commonly present without an obvious etiology, but computed tomography (CT) can provide rapid, comprehensive anatomic evaluation of potential OHCA causes.
Purpose: To assess the diagnostic capabilities of whole body CT imaging in OHCA survivors.
Methods:  From 11/2015 to 2/2018, the CT-FIRST (CT Feasibility In Resuscitated patient for Sudden death Triage) protocol enrolled 104 OHCA survivors without obvious OHCA cause to an early (<6 hours from hospital arrival) dual source Sudden Death CT (SDCT) scan protocol that included a non-contrast head, ECG-gated cardiac/thoracic angiography, and non-gated venous phase abdominal CT's. Cardiac CT analysis was blinded, but other SDCT findings were clinically available. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate CT were excluded. Primary endpoints were SDCT diagnosis compared to OHCA causes from adjudicated record review, and any significantly altered therapy based on SDCT. Acute coronary syndrome by SDCT was conservatively assumed if >50% stenosis was identified in major coronary artery(ies).
Results: SDCT scans identified 39% (41/104) of all OHCA causes and 95% (41/43) of causes potentially identifiable with SDCT (Table). No inappropriate treatments resulted from SDCT findings. SDCT changed or expedited treatments in 21/23 (95%) patients, including antibiotics, anticoagulants, and invasive evaluations or treatments. SDCT found or confirmed resuscitation complications including liver/spleen laceration (n=5), pneumothorax (n=7), and hemopericardium (n=1).
Conclusion: This pilot study suggests the SDCT protocol has considerable promise to diagnose OHCA causes and complications of resuscitation, as well as change clinical treatment.

N=104

OHCA Cause

N (%)

SDCT Diagnosis of OHCA Cause

N(%)

Acute coronary syndrome

13 (13%)

13 (100%)

Cardiomyopathy

8 (8%)

7 (88%)

Pneumonia

11 (11%)

11 (100%)

Hemorrhagic stroke

3 (3%)

3 (100%)

Pulmonary embolism

4 (3%)

4 (100%)

Perforated viscus

Gut necrosis

2 (2%)

1 (1%)

2 (100%)

1 (100%)

Pulmonary hemorrhage

1 (1%)

1 (100%)

Substance use

22 (21%)

0 (0%)

Unknown

7 (7%)

0 (0%)

Other

32 (31%)

0 (0%)

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