THE CONTRIBUTION OF WHOLE-BODY COMPUTED TOMOGRAPHY TO PATIENT MANAGEMENT IN NON-TRAUMATIC OUT-OF-HOSPITAL CARDİAC ARRESTS


Yalçınlı S.

7. Avrasya Acil Tıp Kongresi ve 17. Türkiye Acil Tıp Kongresi’ne, Antalya, Turkey, 25 - 28 November 2021, pp.323-324

  • Publication Type: Conference Paper / Full Text
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.323-324

Abstract

S-075 THE CONTRIBUTION OF WHOLE-BODY COMPUTED TOMOGRAPHY TO PATIENT MANAGEMENT

IN NON-TRAUMATIC OUT-OF-HOSPITAL CARDİAC ARRESTS

Sercan Yalçınlı

Ege Üniversitesi Tıp Fakültesi Hastanesi Acil Tıp Anabilim Dalı

OBJECTIVE: There is limited evidence to recommend using whole-body computed tomography (WBCT) to

determine the cause of out-of-hospital cardiac arrests (OHCA). This study aimed to explain the contribution of

WBCT findings obtained in OHCA patients admitted to ED in diagnosing the etiology of arrest and determining

complications associated with resuscitation.

MATERIAL and METHODS: We retrospectively reviewed the data of patients who underwent cardiopulmonary

resuscitation (CPR) between January 2021 and September 2021 in a tertiary care university hospital. Age, gender,

comorbidities of the patients, clinician's pre-diagnosis of the etiology of the arrest, WBCT findings, final diagnoses

were investigated. Preliminary diagnosis and WBCT findings were compared according to the definitive diagnosis.

Critical intervention requirements after WBCT, complications related to resuscitation effort, need for intervention

for complications, ED outcome of the patients were investigated.

RESULT: In total, we analyzed the data of 509 patients electronically. Patients with in-hospital cardiac arrest

(n:245), traumatic arrest (n:22), toxicological arrest (n:4) were excluded. We identified 238 patients with OHCA.

Post-resuscitation, 47 patients were observed to return spontaneous circulation (ROSC) (19.7%). WBCT was

performed in 35 (74.4%) of these 47 patients. Study data were evaluated on these 35 patients. The mean age of

the patients was 62.9±16.5 (Min:22- Max:92). The male gender comprised 60% of the patients (n:24). The most

common comorbidities were hypertension (42.9%, n:15), diabetes mellitus (40%, n:14), coronary artery disease

(25.7%, n:9), heart failure (20, n:7), chronic renal failure (14.3%, n:5). Preliminary diagnoses of the physicians on

cause of arrest were associated with cardiac thrombosis (28.6%, n:10), hypoxic causes (28.6%, n:10), uncertain

state (20%, n:7), pulmonary embolism ( 11.4%, n:4), CNS bleeding (5.7%, n:2), metabolic causes (5.7%, n:2).

There was a 34.3% (n:12) agreement between the preliminary diagnoses of the patients and the WBCT findings.

The proportion of patients whose preliminary diagnosis was correct but WBCT did not support this was 31.4%

(n:11). The rate of patients whose WBCT decision was correct but the prediagnosis was incorrect was 14.3%

(n:5). In 8.6% (n:3) of the patients, the WBCT finding explained the uncertain prediagnosis. In 11.4% (n:4) of the

patients, neither the prediagnosis nor the WBCT could determine the arrest causes (Figure 1). After the diagnosis

with WBCT, a critical intervention was applied to 3 patients. One patient was operated on due to mesenteric

ischemia, thrombolytic therapy was applied to one patient for pulmonary embolism, and tube thoracostomy was

performed on one patient due to pneumothorax. Complications that may be associated with CPR are rib fractures

(n:16), pneumothorax (n:2) lung contusion (n:2), sternum fracture (n:1), right intubation (n:3), pneumomediastinum

(n:1), subcutaneous emphysema (n:1) was observed. Except for the correction of endotracheal tube malposition

and tube thoracostomy in one patient, no intervention was required for other complications. It was determined

that 37.1% (n: 13) of the patients died in the emergency department, 37.1% (n: 13) were admitted to the intensive

care unit, and 25.7% (n: 9) were referred to another center.

CONCLUSION: WBCT may be helpful to detect OHCA causes in uncertain clinical states. CPR-related

complications can be seen with WBCT. However, these complications seem to be detectable with plain

radiographs. More data are needed to recommend the routine use of WBCT in patients with OHCA.

Keywords: Diagnosis, Out of Hospital Cardiac Arrest, Whole-Body Computed Tomography