Early computed tomographic evaluation for out-of-hospital cardiac arrest survivors: The CT-FIRST trial
Branch KR, Gatewood MO, Kudenchuk P, Lee JC, Strote J, Petek BJ, De Boer I, Carlbom D, Shuman WP, Counts CR, Sayre MR, and Gunn M. Early computed tomographic evaluation for out-of-hospital cardiac arrest survivors: The CT-FIRST trial. Eur Heart J 2019; 40:3767.
Eur Heart J
Background: Patients surviving an out-of-hospital cardiac arrest (OHCA) commonly present without an obvious etiology, but computed tomography (CT) can provide rapid, comprehensive anatomic evaluation of potential OHCA causes. Purpose: To assess the diagnostic capabilities of whole body CT imaging in OHCA survivors. Methods: From 11/2015 to 2/2018, the CT-FIRST (CT Feasibility In Resuscitated patient for Sudden death Triage) protocol enrolled 104 OHCA survivors without obvious OHCA cause to an early (<6 hours from hospital arrival) dual source Sudden Death CT (SDCT) scan protocol that included a non-contrast head, ECG-gated cardiac/thoracic angiography, and non-gated venous phase abdominal CT's. Cardiac CT analysis was blinded, but other SDCT findings were clinically available. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate CT were excluded. Primary endpoints were SDCT diagnosis compared to OHCA causes from adjudicated record review, and any significantly altered therapy based on SDCT. Acute coronary syndrome by SDCT was conservatively assumed if >50% stenosis was identified in major coronary artery(ies). Results: SDCT scans identified 39% (41/104) of all OHCA causes and 95% (41/43) of causes potentially identifiable with SDCT (Table). No inappropriate treatments resulted from SDCT findings. SDCT changed or expedited treatments in 21/23 (95%) patients, including antibiotics, anticoagulants, and invasive evaluations or treatments. SDCT found or confirmed resuscitation complications including liver/spleen laceration (n=5), pneumothorax (n=7), and hemopericardium (n=1). Conclusion: This pilot study suggests the SDCT protocol has considerable promise to diagnose OHCA causes and complications of resuscitation, as well as change clinical treatment.