The value of computed tomography for head trauma in patients presenting with out-of-hospital cardiac arrest before emergency percutaneous coronary intervention.

Abstract

Out-of-hospital cardiac arrest (OHCA) caused by an ST-elevation myocardial infarction (STEMI) is often accompanied by asudden loss of consciousness that may cause the patient to collapse with resulting head trauma, leading to asuspicion of possible intracranial haemorrhage. To rule out intracranial haemorrhage before emergency percutaneous coronary intervention (PCI), emergency computed tomography (CT) of the head might be useful but also causes adelay in percutaneous STEMI treatment. The medical records of all adult patients that presented with OHCA to the emergency department (ED) of the University Medical Centre Utrecht (UMCU), the Netherlands between 16February 2020 and 16February 2022 were reviewed. Atotal of 263 patients presented to the ED with an OHCA; 50presented with aSTEMI requiring emergency PCI. Thirty-nine (78%) patients with aSTEMI were immediately referred to the catheterisation laboratory and 11(22%) STEMI patients underwent aCT scan prior to emergency angiography; in no case was PCI deferred on the basis of the CT findings. The dominant indication for CT of the head was collapse, reported by 10patients and resulting in avisible traumatic head injury in 7patients. In none of the patients was intracranial haemorrhage detected. However, there was adelay between presentation to the ED and arrival at the catheterisation laboratory in patients who underwent CT of the head (mean 63 ± 25 min) before emergency PCI compared to patients without aCT scan (mean 37 ± 21 min). CT of the head did not result in adiagnosis of intracranial haemorrhage or deferral of PCI but did delay PCI treatment for STEMI in patients presenting with OHCA.