在复苏后治疗中应用头到骨盆猝死后 CT 成像的诊断率、安全性和结局：CT FIRST 队列研究。
Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.
机构信息
Division of Cardiology, University of Washington, Seattle, WA, USA.
Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
出版信息
Resuscitation. 2023 Jul;188:109785. doi: 10.1016/j.resuscitation.2023.109785. Epub 2023 Apr 3.
AIM
Our aim was to test whether a head-to-pelvis CT scan improves diagnostic yield and speed to identify causes for out of hospital circulatory arrest (OHCA).
METHODS
CT FIRST was a prospective observational pre-/post-cohort study of patients successfully resuscitated from OHCA. Inclusion criteria included unknown cause for arrest, age >18 years, stability to undergo CT, and no known cardiomyopathy or obstructive coronary artery disease. A head-to-pelvis sudden death CT (SDCT) scan within 6 hours of hospital arrival was added to the standard of care for patients resuscitated from OHCA (post-cohort) and compared to standard of care (SOC) alone (pre-cohort). The primary outcome was SDCT diagnostic yield. Secondary outcomes included time to identifying OHCA cause and time-critical diagnoses, SDCT safety, and survival to hospital discharge.
RESULTS
Baseline characteristics between the SDCT (N = 104) and the SOC (N = 143) cohorts were similar. CT scans (either head, chest, and/or abdomen) were ordered in 74 (52%) of SOC patients. Adding SDCT scanning identified 92% of causes for arrest compared to 75% (SOC-cohort; p value < 0.001) and reduced the time to diagnosis by 78% (SDCT 3.1 hours, SOC alone 14.1 hours, p < 0.0001). Identification of critical diagnoses was similar between cohorts, but SDCT reduced delayed (>6 hours) identification of critical diagnoses by 81% (p < 0.001). SDCT safety endpoints were similar including acute kidney injury. Patient survival to discharge was similar between cohorts.
DISCUSSION
SDCT scanning early after OHCA resuscitation safely improved the efficiency and diagnostic yield for causes of arrest compared to the standard of care alone.
CLINICAL TRIALS NUMBER
NCT03111043.
目的
本研究旨在检验头-骨盆 CT 扫描是否能提高诊断率并加快速度，以明确院外心搏骤停（OHCA）的病因。
方法
CT FIRST 是一项前瞻性观察性的病例前后对照研究，纳入了从 OHCA 中成功复苏的患者。纳入标准包括：不明原因的心脏骤停、年龄>18 岁、能够稳定进行 CT 检查、无已知的心肌病或阻塞性冠状动脉疾病。在 OHCA 复苏患者（后队列）的标准治疗基础上增加头-骨盆猝死 CT（SDCT）扫描，并与标准治疗（前队列）进行比较。主要结局是 SDCT 的诊断率。次要结局包括确定 OHCA 病因的时间、时间关键诊断、SDCT 的安全性以及住院期间的生存率。
结果
SDCT 组（n=104）和 SOC 组（n=143）的基线特征相似。在 SOC 组的 74 例患者（52%）中进行了 CT 扫描（头、胸和/或腹部）。与 SOC 组（SDCT 组 92%，SOC 组 75%；p 值<0.001）相比，添加 SDCT 扫描可确定 92%的心脏骤停病因，并将诊断时间缩短 78%（SDCT 组 3.1 小时，SOC 组 14.1 小时，p<0.0001）。两组的关键诊断识别率相似，但 SDCT 可将关键诊断的延迟（>6 小时）识别率降低 81%（p<0.001）。SDCT 的安全性终点也相似，包括急性肾损伤。两组患者的出院生存率相似。
讨论
与单独的标准治疗相比，在 OHCA 复苏后早期进行 SDCT 扫描可安全地提高病因诊断的效率和诊断率。
临床试验注册号
NCT03111043。
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