Abstract
BackgroundThe routine application of whole-body CT after extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) has not been extensively investigated. We aimed to evaluate the benefit of CT in this context.MethodsWe retrospectively analyzed all OHCA patients who had received ECPR between January 2006 to May 2019. Electronic records were reviewed to filter out patients who had a whole-body CT as their first clinical evaluation after ECPR. CT findings and major hospital outcomes were evaluated.ResultsFrom January 2006 to May 2019, 700 patients had received ECPR in our institution. We identified 93 OHCA patients who received whole-body CT as the first clinical evaluation after ECPR. 22.6% of those had no acute findings detected on CT requiring immediate treatment. In the remaining 77.4%, CT had findings that might lead to alterations in clinical course. Most important findings were myocardial infarction (57.0%), hypoxic brain injury (29.0%), sternal/rib fractures (16.1%), aortic dissection (7.5%), pulmonary embolism (5.4%), and cardiac tamponade (5.4%). There were no significant differences in ICU/hospitalization days, time on ECMO support, survival and neurological outcomes between those with and without immediate CT. In our OHCA cohort, there were 27 patients with CT evidence of hypoxic brain injury, of whom 22.2% (n = 2) managed to wean from ECMO support, 14.8% (n = 4) survived to discharge, but only 3.7% (n = 1) survived with good neurological outcome. Hypoxic brain injury on CT has a 95% specificity in predicting poor neurological outcome, with a false positive rate of only 3.7%. Logistic regression suggested a potential correlation between CT findings of hypoxic brain injury and poor neurological outcome [Odds ratio (OR) = 12.53 (1.55 to 10.1), p = 0.02)].ConclusionsRoutine whole-body CT after ECPR in OHCA patients appears to have a limited role, as the majority is caused by ACS. However, it may be a useful tool when CPR-related injury or non-ACS causes of OHCA are suspected, as well as in cases where the cause of OHCA is unknown. On the contrary, routine brain CT may be a valuable tool in guiding anticoagulant therapy during ECMO and in aiding outcome prediction.
Highlights
According to the American Heart Association (AHA), there were more than 350,000 cases of out-of-hospital cardiac arrests (OHCA) in the United States in 2016, with a survival to discharge rate of only 11.4% [1]
Routine whole-body Computed tomography (CT) after extracorporeal cardiopulmonary resuscitation (ECPR) in OHCA patients appears to have a limited role, as the majority is caused by acute coronary syndrome (ACS)
Clinical and post-mortem studies have demonstrated that acute coronary syndrome (ACS) is the most common cause of OHCA [5], studies have shown that non-ACS causes account for approximately 22–34% of OHCA cases [5], which are potentially treatable if early diagnosis and treatment are achieved
Summary
According to the American Heart Association (AHA), there were more than 350,000 cases of out-of-hospital cardiac arrests (OHCA) in the United States in 2016, with a survival to discharge rate of only 11.4% [1]. The use of extracorporeal membrane oxygenation (ECMO) in OHCA patient refractory to conventional cardiopulmonary resuscitation (CPR) has significantly increased the survival rate to as high as 38.7% [2,3,4]. The routine use of whole-body CT after return of spontaneous circulation (ROSC) in OHCA has not been extensively investigated and the diagnostic values remain uncertain, especially after ECPR. This study was conducted to investigate the value of early whole-body CT after ECPR in OHCA patient. The routine application of whole-body CT after extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) has not been extensively investigated. We aimed to evaluate the benefit of CT in this context
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More From: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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