title: Benefit of an early and systematic imaging procedure after cardiac arrest: insights from the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) registry.
abstract: OBJECTIVE
  Identification of the cause of out-of-hospital cardiac arrest (OHCA) is of paramount importance. We investigated the ability of our imaging strategy to provide an early etiological diagnosis of OHCA and the influence of this strategy on ICU survival.
  
  
  METHODS
  Retrospective review of a prospectively acquired ICU database (01/2000-12/2010) including all OHCA patients without obvious extracardiac cause, for which an early diagnosis research was conducted (coronary angiography and/or brain and chest CT scan) within 24h after resuscitation. These procedures could be performed separately or be combined, according to a decision algorithm.
  
  
  RESULTS
  Of the 1274 patients admitted after OHCA during this 10-year period, the imaging strategy was applied in 896 patients. Patients who benefited from coronary angiography and/or CT scan were admitted to our ICU after a median delay of 180 [130-220]min after resuscitation. Seven hundred and forty-five coronary angiographies were performed, of which 452 (61%) identified at least one significant coronary lesion deemed responsible for the OHCA. CT-scan was performed in 355 patients and provided a diagnosis in 72 patients (20%), mainly stroke (n=38) and pulmonary embolism (n=19). Overall, this strategy allowed early diagnosis in 524 patients (59%). ICU survival was significantly higher for patients with a diagnosis identified by coronary angiography as compared with CT-scan (43% vs 10%, p<0.001).
  
  
  CONCLUSIONS
  The use of an early diagnosis protocol with immediate coronary angiography and/or CT scan provided the etiology of nearly two thirds of OHCA cases. In this large retrospective database, coronary angiography yielded a better diagnostic value than brain and/or chest CT-scan.
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chelly
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mongardon
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Olivier
authors.initials: O
authors.lastname: Vignaux
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D000465:Algorithms; D017023:Coronary Angiography; D003663:Decision Trees; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging* / Q000209:etiology*; D010297:Paris; D012042:Registries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed