Early in-hospital management of cardiac arrest from neurological cause: Diagnostic pitfalls and treatment issues

Resuscitation. 2018 Nov:132:147-155. doi: 10.1016/j.resuscitation.2018.08.004. Epub 2018 Aug 4.

Abstract

Purpose: To explore diagnostic pitfalls and treatment issues in out-of-hospital cardiac arrest of neurological cause (OHCA-NC).

Methods: Retrospective analysis of all consecutive patients from the Paris Sudden Death Expertise Centre (France) registry from May 2011 to September 2015 presenting with a sustained return of spontaneous circulation (ROSC) at hospital admission and a final diagnosis of OHCA-NC. Description of the early diagnostic check-up performed to identify the cause of cardiac arrest. Logistic multivariate regression to identify factors associated with immediate coronary angiography (iCAG) in OHCA-NC patients.

Results: Among 3542 patients with ROSC, a final diagnosis of OHCA-NC was established in 247 (7%). The early diagnostic check-up consisted in a total of 207 (84%) immediate cranial CT-scan, 66 (27%) iCAG and 25 (10%) chest CT-scan. The brain CT-scan allowed identifying a neurovascular cause in 116 (47%) patients. An iCAG was performed as the first line exam in 57 (23%) patients, in whom a final diagnosis of neurovascular cause for OHCA-NC was later identified in 41 patients. By multivariate analysis, decision for iCAG was independently associated with ST-segment elevation on post-ROSC electrocardiogram (OR, 5.94; 95%CI, 2.14-18.28; P = 0.0009), whereas an obvious cause of cardiac arrest on scene was negatively associated with iCAG (OR, 0.14; 95%CI, 0.02-0.51; P = 0.01).

Conclusions: OHCA-NC is a rare event that is mainly related to neurovascular causes. The initial ECG pattern may be a confounder regarding triage for early diagnostic check-up. Further studies are required to explore the potential harmfulness associated with decision to perform an iCAG in this population.

Keywords: Cardiopulmonary resuscitation; Coronary angiogram; Epilepsy; Subarachnoid haemorrhage; Sudden death.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brain / diagnostic imaging*
  • Cerebrovascular Disorders / complications
  • Cerebrovascular Disorders / diagnosis
  • Coronary Angiography / statistics & numerical data
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurologic Examination / statistics & numerical data
  • Out-of-Hospital Cardiac Arrest / etiology*
  • Out-of-Hospital Cardiac Arrest / mortality
  • Paris / epidemiology
  • Registries
  • Retrospective Studies
  • Tomography, X-Ray Computed