title: The role of cranial computed tomography in the immediate post-cardiac arrest period.
abstract: Patients who initially survive cardiac arrest are often admitted to an intensive care unit comatose and on mechanical ventilation. It is not clear whether or not a screening cranial computed tomography (CT scan) is necessary in the immediate post-arrest period. We hypothesized that there may be clinically relevant information gleaned from head CT scans obtained early in the post-arrest period that could affect immediate management of these patients, even when non-neurologic causes of cardiac arrest are suspected. A retrospective data analysis was conducted of all survivors (age >18 years) of non-traumatic out-of-hospital cardiac arrest (OHCA) who underwent non-contrast head CT (NCHCT) within the first 24 h of admission. A total of 84 patients were identified and 51 (60.7%) met the inclusion criteria. As much as 45 (88.2%) patients in the total cohort had an NCHCT negative for ICH or herniation; of this group, 39 (76.5%) had a normal NCHCT, while six (11.8%, 95% CI: 5.1-23.8%) demonstrated varying degrees of cerebral edema or loss of gray-white matter distinction consistent with anoxic brain injury, but without herniation. Six patients (11.8%, 95% CI: 5.1-23.8%) exhibited findings consistent with either an ICH (with or without herniation) or herniation without an ICH. Four (7.8%) of these patients had an ICH without herniation, one had an acute SAH with edema and herniation, and one had frank herniation due to massive cerebral edema. The overall incidence of any kind of intracranial hemorrhage in our cohort was 9.8% (95% CI: 3.8-21.4%). In this cohort of post-cardiac arrest patients who underwent cranial computed tomography, 11.8% of patients had clinically significant abnormalities identified. The exact role of neuroimaging in this population is still in evolution, and further prospective evaluation is warranted.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mcocchi@bidmc.harvard.edu
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.forename: Jason M
authors.initials: JM
authors.lastname: Lucas
authors.forename: Justin
authors.initials: J
authors.lastname: Salciccioli
authors.forename: Erin
authors.initials: E
authors.lastname: Carney
authors.forename: Susan
authors.initials: S
authors.lastname: Herman
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
mesh_terms: D001929:Brain Edema / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000000981:diagnostic imaging; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
references.citation: JAMA. 2008 Sep 24;300(12):1432-8
references.pmid: 18812534
references.citation: Circulation. 2008 Jan 29;117(4):e25-146
references.pmid: 18086926
references.citation: J Neurol Sci. 2007 Oct 15;261(1-2):108-17
references.pmid: 17568611
references.citation: No Shinkei Geka. 1993 Sep;21(9):781-6
references.pmid: 8377893
references.citation: Resuscitation. 2009 Sep;80(9):977-80
references.pmid: 19581033
references.citation: Resuscitation. 2005 Sep;66(3):271-83
references.pmid: 16129543
references.citation: Am J Emerg Med. 2009 Jan;27(1):63-67
references.pmid: 19041535
references.citation: J Headache Pain. 2009 Oct;10(5):357-60
references.pmid: 19597939
references.citation: Resuscitation. 2005 Jan;64(1):97-101
references.pmid: 15709219
references.citation: Resuscitation. 2001 Oct;51(1):27-32
references.pmid: 11719170
references.citation: Eur Heart J. 1997 Jul;18(7):1122-8
references.pmid: 9243146
references.citation: Crit Care Med. 1993 Jan;21(1):104-10
references.pmid: 8420715
references.citation: Circulation. 1991 Aug;84(2):960-75
references.pmid: 1860248
references.citation: Emerg Med J. 2008 Oct;25(10):666-9
references.pmid: 18843066
references.citation: J Neurol. 1997 Sep;244(9):556-61
references.pmid: 9352452
references.citation: Stroke. 2000 Sep;31(9):2163-7
references.pmid: 10978046
references.citation: Resuscitation. 2004 Oct;63(1):55-63
references.pmid: 15451587
references.citation: JAMA. 2008 Sep 24;300(12):1423-31
references.pmid: 18812533