Abstract 215: Post Arrest Head CT Imaging: Commonly Done, but not a Determinant of Early Care Withdrawal

Abstract

Background: The decision to perform head CT, following non-traumatic cardiac arrest, is based on clinical judgment. We examined whether such expensive testing, factored into early care decisions. Methods: We studied 202 out-of-hospital, non traumatic, cardiac arrest survivors and analyzed patients who had Head CT imaging performed within 72 hours of admission. Grossly abnormal results were defined as severe diffuse brain edema, herniation or bleeding. Demographics, cardiac arrest characteristics and hospital care were studied in patients with and without abnormal CT finding using Chi square and t test. Logistic regression was used to identify the impact of abnormal head CT findings on early care withdrawal. Results: Of 202 patients studied, 137 had CT imaging (67%). Of these 112 patients (81%) had an unremarkable (“normal”) head CT (group1) whereas 25 patients (18%) had abnormal head CT findings as described above (group2). Mean age for patients receiving a head CT was 61 years (SD±15).No obvious demographic feature emerged as a characteristic or a predictor of an abnormal head CT (PNS, Table1). An abnormal head CT prompted more family meetings, further neurological evaluation (all P<0.05) but did not result in early care withdrawal {within 72 hours of admission} as compared to those with an unremarkable study [OR=1.2, 95% CI (0.4-3) P=0.64]. Conclusion: Although head CT is often performed post arrest, grossly abnormal findings are uncommonly found, and do not predict early care withdrawal. The clinical usefulness of this test in guiding decision making remains unclear and unsubstantiated.