The authors did not give detailed information on why patients were excluded particularly in the SDCT enrollment period when the vast majority of ROSC patients were not included.Risk of selection bias based on the large number of patients that were not included.Observational, before and after studies cannot show causality they can only reveal associations.Post-arrest care (aside from the studied intervention) appears to be similar between the two groups.Most baseline demographics were similar between the two groups.Investigates an important area with limited prior research.CT scanning was common in the standard care cohort (84% received at least one CT – usually NCHCT)ĭelayed Ascertainment of Time Critical Diagnosis.Most common reason for exclusion: Patient was not scanned.111 of 307 patients with ROSC after OHCA were eligible for enrollment.Most common reason for exclusion: Would not have been able to undergo SDCT.143 of 273 patients with ROSC after OHCA were eligible for enrollment.Known obstructive coronary artery disease or known coronary stent.Indication for emergency invasive coronary angiography or had coronary angiography within 1 hour of arrival.

Obvious cause for OHCA prior to SDCT or on hospital arrival.Intervention: “The SDCT scan protocol consisted of three CT scans: 1) a non-contrast head CT, 2) retrospective ECG-gated thoracic CT contrast angiogram for most of the cardiac cycle (initially 20–90% and later 30–80% of the cardiac cycle to reduce radiation dose), and 3) a venous phase, non-ECG gated, spiral abdominal and pelvis CT,” performed within 6 hours of presentation.Ĭontrol: Standard approach to diagnosis post-arrest but would be eligible for SDCT.ĭesign: Prospective, observational, before and after implementation of a protocol study. Delayed diagnosis > 6 hours from hospital arrival.Primary: Diagnostic yield (defined as the number of patients with an adjudicated diagnosis that was the presumed cause for OHCA) of SDCT in comparison to standard practice in identifying the cause of cardiac arrest.Population: Patients successfully resuscitated from OHCA without a clear diagnosis on presentation who were stable for CT. PMID: 37019352Ĭlinical Question: Does protocolized head-to-pelvis sudden death CT (SDCT) scanning improved the diagnostic yield post-ROSC in comparison to standard practice? Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Advanced imaging post-arrest is a possible modality to achieve this end.Īrticle: Branch KHR et al. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management. Although myocardial infarction, dysrhythmias and pulmonary emboli are common pathologies to consider, there are a host of other causes including subarachnoid hemorrhage, trauma and electrolyte disturbances.

Identification of the underlying cause of the cardiac arrest is a critical area of focus in post-arrest care. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC.

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