A descriptive analysis of cross-sectional imaging findings in patients after non-traumatic sudden cardiac arrest

Resusc Plus. 2021 Jan 28:5:100077. doi: 10.1016/j.resplu.2021.100077. eCollection 2021 Mar.

Abstract

Introduction: Cross-sectional imaging is frequently obtained after sudden cardiac arrest (SCA) to determine the aetiology. Although imaging studies may reveal acute and/or chronic findings that may impact downstream medical management, lack of standardized guidelines results in significant practice variability. We aimed to perform a descriptive analysis and to report on radiographic findings after SCA.

Methods: This was a retrospective observational descriptive study that included all adult SCA patients who presented to our emergency department (ED) over a 6-year period, achieved sustained return of spontaneous circulation, and subsequently received cross-sectional imaging while in the ED. Each imaging study was reviewed and graded based on a predefined scale, and significant radiographic findings were tabulated.

Results: 1573 patients were identified, and 452 patients remained after applying predefined exclusion criteria. A total of 298, 184, and 113 computed tomography (CT) studies were performed of the head, chest, and abdomen, respectively. For head, chest, and abdominal imaging, 13 (4.4%), 23 (12.5%), and 6 (5.3%) studies had radiographic findings that likely contributed to SCA, respectively. Altogether, 42 (7.1%) radiographic studies had findings that likely contributed to SCA. Eighty (13.4%) studies (head [n = 38, 12.8%], chest [n = 26, 14.1%], abdomen [n = 16, 14.2%]) resulted in a change of clinical care (e.g. specialty consultation or procedures).

Conclusion: Given the clinical uncertainty and relative instability during the post-SCA phase, cross-sectional imaging frequently reveals important acute and chronic diagnostic findings.

Keywords: ACLS, advanced cardiac life support; ACS, acute coronary syndrome; CT, computed tomography; Cross-Sectional imaging; ED, emergency department; MR, Imagnetic resonance imaging; OHCA, out-of-hospital cardiac arrest; PEA, pulseless electrical activity; Post-Cardiac arrest management; ROS, Creturn of spontaneous circulation; Resuscitation; SCA, sudden cardiac arrest; Sudden cardiac arrest; VF, ventricular fibrillation; VT, ventricular tachycardia; WBCT, whole body computed tomography; eCPR, extracorporeal cardiopulmonary resuscitation.