Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

Autor: Branch KRH; Division of Cardiology, University of Washington, Seattle, WA, USA. Electronic address: kbranch@uw.edu., Gatewood MO; Department of Emergency Medicine, University of Washington, Seattle, WA, USA., Kudenchuk PJ; Division of Cardiology, University of Washington, Seattle, WA, USA., Maynard C; Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA., Sayre MR; Department of Emergency Medicine, University of Washington, Seattle, WA, USA., Carlbom DJ; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, USA., Edwards RM; Department of Radiology, University of Washington, Seattle, WA, USA., Counts CR; Department of Emergency Medicine, University of Washington, Seattle, WA, USA., Probstfield JL; Division of Cardiology, University of Washington, Seattle, WA, USA., Brusen R; Kaiser Permanente, WA, USA., Johnson N; Department of Emergency Medicine, University of Washington, Seattle, WA, USA., Gunn ML; Department of Radiology, University of Washington, Seattle, WA, USA; TRG Imaging, Auckland, New Zealand.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2023 Jul; Vol. 188, pp. 109785. Date of Electronic Publication: 2023 Apr 03.
DOI: 10.1016/j.resuscitation.2023.109785
Abstrakt: Aim: Our aim was to test whether a head-to-pelvis CT scan improves diagnostic yield and speed to identify causes for out of hospital circulatory arrest (OHCA).
Methods: CT FIRST was a prospective observational pre-/post-cohort study of patients successfully resuscitated from OHCA. Inclusion criteria included unknown cause for arrest, age >18 years, stability to undergo CT, and no known cardiomyopathy or obstructive coronary artery disease. A head-to-pelvis sudden death CT (SDCT) scan within 6 hours of hospital arrival was added to the standard of care for patients resuscitated from OHCA (post-cohort) and compared to standard of care (SOC) alone (pre-cohort). The primary outcome was SDCT diagnostic yield. Secondary outcomes included time to identifying OHCA cause and time-critical diagnoses, SDCT safety, and survival to hospital discharge.
Results: Baseline characteristics between the SDCT (N = 104) and the SOC (N = 143) cohorts were similar. CT scans (either head, chest, and/or abdomen) were ordered in 74 (52%) of SOC patients. Adding SDCT scanning identified 92% of causes for arrest compared to 75% (SOC-cohort; p value < 0.001) and reduced the time to diagnosis by 78% (SDCT 3.1 hours, SOC alone 14.1 hours, p < 0.0001). Identification of critical diagnoses was similar between cohorts, but SDCT reduced delayed (>6 hours) identification of critical diagnoses by 81% (p < 0.001). SDCT safety endpoints were similar including acute kidney injury. Patient survival to discharge was similar between cohorts.
Discussion: SDCT scanning early after OHCA resuscitation safely improved the efficiency and diagnostic yield for causes of arrest compared to the standard of care alone.
Clinical Trials Number: NCT03111043.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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