Department of Cardiology, University of Washington, Seattle, Washington, USA.
Department of Emergency Medicine, University of Washington, Seattle, Washington, USA.
Acad Emerg Med. 2021 Apr;28(4):394-403. doi: 10.1111/acem.14228. Epub 2021 Mar 24.
Patients resuscitated from an out-of-hospital circulatory arrest (OHCA) commonly present without an obvious etiology. We assessed the diagnostic capability and safety of early head-to-pelvis computed tomography (CT) imaging in such patients.
From November 2015 to February 2018, we enrolled 104 patients resuscitated from OHCA without obvious cause (idiopathic OHCA) to an early sudden-death CT (SDCT) scan protocol within 6 h of hospital arrival. The SDCT protocol included a noncontrast CT head, an electrocardiogram-gated cardiac and thoracic CT angiogram, and a nongated venous-phase abdominopelvic CT angiogram. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate SDCT were excluded. Cardiac CT analyses were blinded, but other SDCT findings were clinically available. Primary endpoints were the number of OHCA causes identified by SDCT compared to the adjudicated cause and critical diagnoses identified by SDCT, including resuscitation complications. Safety endpoints were acute kidney injury (AKI) and inappropriate treatments based on SDCT findings. Acute coronary syndrome was the presumed etiology if any major coronary artery had a >50% stenosis without another OHCA cause.
SDCT scans occurred within 1.9 ± 1.0 h of hospital arrival and identified 39% (41/104) of all OHCA causes and 95% (39/41) of causes potentially identifiable by SDCT. Critical findings were identified by SDCT in 98% (43/44) of patients that included potentially life-threatening resuscitation complications of liver or spleen laceration (n = 6); pneumothorax or thoracic organ laceration (n = 8); and mediastinal, pericardial, or vascular hemorrhage (n = 3). SDCT exclusively identified 13 (13%) OHCA causes that would otherwise not be identified without SDCT imaging. No inappropriate treatments resulted from SDCT findings. AKI was common (28%) but only one (1%) patient required new dialysis.
This observational cohort study suggests that early SDCT scanning is safe, can expedite the diagnosis of potential causes, and can meaningfully change clinical management after idiopathic OHCA.
从院外循环骤停（OHCA）中复苏的患者通常没有明显的病因。我们评估了早期头到骨盆计算机断层扫描（CT）成像在这类患者中的诊断能力和安全性。
从 2015 年 11 月至 2018 年 2 月，我们纳入了 104 名从 OHCA 中复苏但无明显病因（特发性 OHCA）的患者，在入院后 6 小时内进行早期突然死亡 CT（SDCT）扫描方案。SDCT 方案包括非增强 CT 头部、心电图门控心脏和胸部 CT 血管造影，以及非门控静脉期腹部骨盆 CT 血管造影。排除需要紧急心脏导管插入术或血流动力学不能耐受 SDCT 的患者。心脏 CT 分析是盲法的，但其他 SDCT 结果在临床上是可用的。主要终点是 SDCT 确定的 OHCA 原因数量与裁决原因以及 SDCT 确定的危急诊断（包括复苏并发症）相比。安全终点是基于 SDCT 结果的急性肾损伤（AKI）和不适当的治疗。如果任何主要冠状动脉狭窄>50%而没有其他 OHCA 原因，则假定急性冠状动脉综合征为病因。
SDCT 扫描在入院后 1.9±1.0 小时内进行，确定了所有 OHCA 原因的 39%（41/104）和 SDCT 可能确定的 95%（39/41）的原因。SDCT 在 98%（43/44）的患者中确定了危急发现，其中包括潜在威胁生命的肝或脾撕裂的复苏并发症（n=6）；气胸或胸部器官撕裂（n=8）；纵隔、心包或血管出血（n=3）。SDCT 单独确定了 13 例（13%）OHCA 原因，如果没有 SDCT 成像，否则无法确定这些原因。没有因 SDCT 结果而进行不适当的治疗。AKI 很常见（28%），但只有 1 例（1%）患者需要新的透析。
这项观察性队列研究表明，早期 SDCT 扫描是安全的，可以加速潜在病因的诊断，并在特发性 OHCA 后有意义地改变临床管理。
