Abstract 01: Diagnostic Yield, Safety, and Outcomes with Head-to-Pelvis Sudden Death Computed Tomographic Imaging after Idiopathic Out-of-Hospital Cardiac Arrest: The CT First Cohort Study

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Introduction: In survivors of out-of-hospital cardiac arrest without an obvious cause (idiopathic OHCA), diagnosing OHCA causes and complications is challenging in early post-arrest care. Hypothesis: Head-to-pelvis sudden death computerized tomographic CT angiography (SDCT) <6 hours after successful resuscitation will improve the time and diagnostic ability to identify the etiology of OHCA and time-critical diagnoses compared to the standard of care (SOC) alone. Methods: CT FIRST was a prospective observational pre-/post-cohort study of patients successfully resuscitated from OHCA. Inclusion criteria included idiopathic OHCA, age>18 years, clinical stability to undergo SDCT, no known prior cardiomyopathy or obstructive coronary artery disease. SDCT, including ECG-gated thoracic CT, was introduced to the SOC for patients resuscitated from idiopathic OHCA (pre-cohort; years 11/2014-2/2017) and compared to SOC alone (post-cohort, years 1/2011-10/2014). CT scans could be clinically ordered as part of SOC. Primary endpoints were diagnostic SDCT diagnostic yield, time to identify OHCA and time-critical diagnoses, patient safety, and survival to hospital discharge. Results: Baseline characteristics between the SDCT (N=104) and the SOC (N=143) cohorts were similar. A CT scan (head, chest, and/or abdomen) was clinically ordered in 74 (52%) of SOC alone patients. The primary outcomes (Table) demonstrate that compared to SOC alone, SDCT increased the identification of OHCA causes and early diagnosis of time-critical etiologies without an increase in renal insufficiency. SDCT reduced the time to OHCA diagnosis by 78%. Total number of time-critical diagnoses and patient survival to discharge were unchanged between SOC alone and SDCT cohorts. Conclusions: SDCT scanning early after OHCA resuscitation safely improved the efficiency and diagnostic yield for causes of OHCA compared to the standard of care.