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.
Similar content being viewed by others
References
Rosamond W, Flegal K, Furie K et al (2008) Heart disease and stroke statistics––2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 117:e25–e146
Berek K, Schinnerl A, Traweger C et al (1997) The prognostic significance of coma-rating, duration of anoxia and cardiopulmonary resuscitation in out-of-hospital cardiac arrest. J Neurol 244:556–561
Nichol G, Thomas E, Callaway CW et al (2008) Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 300:1423–1431
Sasson C, Hegg AJ, Macy M et al (2008) Prehospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest. JAMA 300:1432–1438
Naples R, Ellison E, Brady WJ (2009) Cranial computed tomography in the resuscitated patient with cardiac arrest. Am J Emerg Med 27:63–67
Inamasu J, Miyatake S, Tomioka H et al (2009) Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study. Resuscitation 80:977–980
Kurkciyan I, Meron G, Sterz F et al (2001) Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest. Resuscitation 51:27–32
Kitahara T, Masuda T, Soma K (1993) The etiology of sudden cardiopulmonary arrest in subarachnoid hemorrhage. No Shinkei Geka 21:781–786
Cummins RO, Chamberlain DA, Abramson NS et al (1991) Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 84:960–975
Langhelle A, Nolan J, Herlitz J et al (2005) Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style. Resuscitation 66:271–283
Kuisma M, Alaspaa A (1997) Out-of-hospital cardiac arrests of non-cardiac origin. Epidemiology and outcome. Eur Heart J 18:1122–1128
Inamasu J, Miyatake S, Tomioka H et al (2009) Headache, cardiac arrest, and intracranial hemorrhage. J Headache Pain 10:357–360
Morimoto Y, Kemmotsu O, Kitami K et al (1993) Acute brain swelling after out-of-hospital cardiac arrest: pathogenesis and outcome. Crit Care Med 21:104–110
Yanagawa Y, Un-no Y, Sakamoto T et al (2005) Cerebral density on CT immediately after a successful resuscitation of cardiopulmonary arrest correlates with outcome. Resuscitation 64:97–101
Torbey MT, Selim M, Knorr J et al (2000) Quantitative analysis of the loss of distinction between gray and white matter in comatose patients after cardiac arrest. Stroke 31:2163–2167
Choi SP, Park HK, Park KN et al (2008) The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest. Emerg Med J 25:666–669
Torbey MT, Geocadin R, Bhardwaj A (2004) Brain arrest neurological outcome scale (BrANOS): predicting mortality and severe disability following cardiac arrest. Resuscitation 63:55–63
Puttgen HA, Geocadin R (2007) Predicting neurological outcome following cardiac arrest. J Neurol Sci 261:108–117
Acknowledgements
This study was funded in part by a grant from the American Heart Association (grant number 0735533T).
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cocchi, M.N., Lucas, J.M., Salciccioli, J. et al. The role of cranial computed tomography in the immediate post-cardiac arrest period. Intern Emerg Med 5, 533–538 (2010). https://doi.org/10.1007/s11739-010-0403-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11739-010-0403-8