Ishida Masanori, Tanaka Taro, Morichi Shinichiro, Uesugi Hirotaka, Nakazawa Haruka, Watanabe Shun, Nakai Motoki, Yamanaka Gaku, Homma Hiroshi, Saito Kazuhiro
Department of Radiology, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Department of Pediatrics and Adolescent Medicine, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Diseases. 2024 Oct 20;12(10):261. doi: 10.3390/diseases12100261.
Whole-body computed tomography (WBCT) is commonly employed for primary screening in pediatric patients experiencing out-of-hospital cardiac arrest (OHCA) without prehospital return of spontaneous circulation (ROSC). This study aimed to evaluate the cause of OHCA on WBCT and compare WBCT findings between ROSC and non-ROSC groups in non-traumatic pediatric OHCA cases in an emergency department setting. A retrospective analysis was conducted on 27 pediatric patients (mean age: 32.4 months; median age: 10 months) who experienced non-traumatic OHCA without prehospital ROSC and were transported to our tertiary care hospital between January 2013 and December 2023. WBCT scans were performed to investigate the cause of OHCA, with recorded findings in the head, chest, abdomen, and subcutaneous tissues. In all cases, the direct causes of OHCA were undetermined, and WBCT identified no fatal findings. Statistical comparisons of CT findings between the ROSC and non-ROSC groups revealed significant differences. The non-ROSC group had a higher incidence of brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic walls, narrowed aorta, gas in the mediastinum, and hepatomegaly compared to the ROSC group. Although WBCT did not reveal the direct cause of OHCA, several CT findings were significantly more frequent in the non-ROSC group, including brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic wall, narrowed aorta, gas in the mediastinum, and hepatomegaly. These findings, resembling postmortem changes, may aid in clinical decision making regarding the continuation or cessation of resuscitation efforts in pediatric OHCA cases.
全身计算机断层扫描（WBCT）通常用于对院外心脏骤停（OHCA）且院前未恢复自主循环（ROSC）的儿科患者进行初步筛查。本研究旨在评估非创伤性儿科OHCA病例在急诊科环境下，WBCT上OHCA的病因，并比较ROSC组和非ROSC组的WBCT表现。对2013年1月至2023年12月期间27例非创伤性OHCA且院前未恢复自主循环并被转运至我们三级医疗中心的儿科患者（平均年龄：32.4个月；中位年龄：10个月）进行了回顾性分析。进行WBCT扫描以调查OHCA的病因，并记录头部、胸部、腹部和皮下组织的检查结果。在所有病例中，OHCA的直接病因均未明确，且WBCT未发现致命性表现。ROSC组和非ROSC组CT表现的统计学比较显示存在显著差异。与ROSC组相比，非ROSC组脑肿胀、脑灰白质分界消失、对称性肺实变/磨玻璃影、心脏扩大、主动脉壁高密度、主动脉缩窄、纵隔积气和肝肿大的发生率更高。尽管WBCT未揭示OHCA的直接病因，但非ROSC组中一些CT表现明显更常见，包括脑肿胀、脑灰白质分界消失、对称性肺实变/磨玻璃影、心脏扩大、主动脉壁高密度、主动脉缩窄、纵隔积气和肝肿大。这些类似于死后改变的表现可能有助于儿科OHCA病例中关于继续或停止复苏努力的临床决策。
