CT imaging in post-resuscitation care of non-traumatic resuscitation room patients in German hospitals.

BACKGROUND

The procedures and locations where patients are admitted to hospitals and subsequently diagnosed after out-of-hospital cardiac arrest (OHCA) in Germany exhibit considerable heterogeneity. Specifically, advanced imaging diagnostic methods via computed tomography (CT) show significant variation in both timing and execution. However, echocardiography (ECHO) is not an alternative to CT in this setting, as both modalities serve distinct diagnostic purposes. This study aimed to comprehensively analyze the status quo analysis of current procedures in German emergency departments (EDs) regarding early-phase (within the first six hours) CT imaging diagnostics after resuscitation and the treatment of critically ill patients in the ED resuscitation room.

METHODS

An anonymized cross-sectional study was conducted from November 28, 2023, to February 18, 2024, using an online survey platform ( https://www.surveymonkey.de ) with a standardized questionnaire. The survey targeted 994 medical directors of German EDs and was distributed through the mailing lists of the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) and the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI). The Medical Faculty of Christian-Albrechts-University Kiel granted ethical approval (D 586/22). An expert panel reviewed the questionnaire to ensure validity and minimize bias. All statistical analyses, including both descriptive and inferential statistics, were conducted using R software.

RESULTS

Out of 994 hospitals contacted, 182 hospitals from 15 German federal states participated, yielding a response rate of 18.3%. The overall completion rate for the whole questionnaire was 12.2% (n = 121/994). In the survey, 9.6% (n = 15/157) of hospitals reported having CT within the resuscitation room, while 70.1% (n = 119/157) had CT within a range of 50 m of the resuscitation room. A standard operating procedure (SOP)/postresuscitation protocol for patients suffering from OHCA was available for 61.1% (n = 88 yes, n = 56 no) of the hospitals. A specific postresuscitation CT protocol (postrCT protocol) was used by 30.0% (n = 48 yes, n = 93 no) of the hospitals, with 59.2% (n = 29) receiving a head-to-pelvis CT (whole-body CT). In hospitals without a CT protocol (n = 84), echocardiography (82.1%, n = 69), abdominal ultrasound (61.9%, n = 52), and non-contrast CT of the head (47.6%, n = 40) are used for distinctive diagnostics. Cardiac Arrest Center (CAC)-certified hospitals were significantly more likely to have a SOP/postresuscitation protocol (91.9 vs. 49.0%, p < 0.001) and a specific postrCT protocol (63.2 vs. 22.1%, p < 0.001) than noncertified hospitals.

CONCLUSION

Currently, there is no nationwide standardized protocol for imaging diagnosis in patients after OHCA in German EDs. Protocols are more often used in CAC hospitals in Germany then in non-certified hospitals. Given the limitations of survey-based research, results should be interpreted with caution regarding their representativeness across all German EDs and further prospective studies including mortality and neurological outcomes are warranted.