Eyler Yesim, Kilic Turgay Yilmaz, Idil Hasan, Er Ali
Department of Emergency Medicine, Izmir City Hospital, Izmir, Turkey.
Department of Radiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey.
Medicine (Baltimore). 2025 Apr 25;104(17):e41998. doi: 10.1097/MD.0000000000041998.
Computed tomography (CT) scans are increasingly requested for nontraumatic out-of-hospital cardiac arrest (OHCA) patients with return of spontaneous circulation (ROSC). CT scan findings contribute to the diagnosis of cardiac arrest and patient management. The primary objective of this study is to determine the causes and frequencies of cardiac arrest in nontraumatic OHCA patients with ROSC, and the secondary objective is to determine the CT preferences of clinicians and the predictive values of CT findings for in-hospital mortality in these patients. The population of this retrospective single-center cohort study consisted of 863 nontraumatic OHCA patients brought to the emergency department of a tertiary hospital between January 1st, 2016, and December 31st, 2020. The study sample consisted of 258 nontraumatic OHCA patients with ROSC aged 18 years and older who underwent radiographic imaging within 24 hours after emergency department admission. Two emergency medicine specialists determined the causes of cardiac arrest based on all available data. Patients' radiological images were re-reported by a radiologist. CT findings associated with in-hospital mortality were determined. The median age of 258 patients included in the sample, 163 (63.2%) of whom were male, was 67 years (interquartile range: 17, min: 18-max: 94). Cardiac arrest occurred primarily due to cardiac causes (35.3%), followed by pulmonary causes (29.1%), while the cause could not be determined in 22.9% of the patients. The radiological imaging method most preferred by clinicians was cranial CT (n = 238, 92.2%), followed by thoracic CT (n = 236, 91.5%) and abdominal CT (n = 141, 54.7%). The in-hospital mortality rate was 88%. Several thoracic CT findings, including infiltration/consolidation (odds ratio: 6.74; 95% confidence interval [CI]: 1.35-33.56, P = .017), chronic lung pathologies (OR: 1.39; 95% CI: 0.44-4.8, P = .026), and chronic lung pathologies accompanied by pneumothorax (OR: 17.5; 95% CI: 1.7-178.4, P = .001) were significantly associated with in-hospital mortality. We found that cardiac causes were the most common causes of cardiac arrest in nontraumatic OHCA patients with ROSC. Additionally, clinicians most frequently requested cranial and thoracic CT for these patients. Of note, thoracic CT findings were significantly associated with in-hospital mortality.
对于恢复自主循环（ROSC）的非创伤性院外心脏骤停（OHCA）患者，计算机断层扫描（CT）检查的需求日益增加。CT扫描结果有助于心脏骤停的诊断和患者管理。本研究的主要目的是确定非创伤性OHCA且恢复自主循环患者心脏骤停的原因及频率，次要目的是确定临床医生对CT检查的偏好以及CT检查结果对这些患者院内死亡率的预测价值。这项回顾性单中心队列研究的对象为2016年1月1日至2020年12月31日期间被送至一家三级医院急诊科的863例非创伤性OHCA患者。研究样本包括258例年龄在18岁及以上、恢复自主循环的非创伤性OHCA患者，这些患者在急诊科入院后24小时内接受了影像学检查。两名急诊医学专家根据所有可用数据确定心脏骤停的原因。患者的放射影像由一名放射科医生重新报告。确定与院内死亡率相关的CT检查结果。样本中258例患者的中位年龄为67岁（四分位间距：17，最小：18 - 最大：94），其中163例（63.2%）为男性。心脏骤停主要由心脏原因引起（35.3%），其次是肺部原因（29.1%），而22.9%的患者病因无法确定。临床医生最常选择的放射影像学检查方法是头颅CT（n = 238，92.2%），其次是胸部CT（n = 236，91.5%）和腹部CT（n = 141，54.7%）。院内死亡率为88%。胸部CT的一些检查结果，包括浸润/实变（比值比：6.74；95%置信区间[CI]：1.35 - 33.56，P = .017）、慢性肺部病变（OR：1.39；95% CI：0.44 - 4.8，P = .026）以及伴有气胸的慢性肺部病变（OR：17.5；95% CI：1.7 - 178.4，P = .001）与院内死亡率显著相关。我们发现，心脏原因是恢复自主循环的非创伤性OHCA患者心脏骤停最常见的原因。此外，临床医生对这些患者最常要求进行头颅和胸部CT检查。值得注意的是，胸部CT检查结果与院内死亡率显著相关。
