CT after CA... worth it?

Here's a good nugget of food for thought from Medscape. We do this too. Outcomes are yet to be viewed though.


January 13, 2017
Daniel M. Lindberg, MD Reviewing Reynolds AS et al., Resuscitation 2017 Jan 3;
Many computed tomography scans showed abnormalities in this retrospective study, but it's not clear that performing early head CT improved care.
Neurological emergencies can result in cardiac arrest, and neurological injury can occur as a result of cardiac arrest. These authors retrospectively assessed the utility of head computed tomography (CT) in patients with out-of-hospital cardiac arrest who survived for at least 24 hours at a single academic center from 2007 to 2015.
Of 213 patients in the analysis, 115 (54%) underwent head CT within 24 hours. In 43 patients (20% of all patients; 37% of those who underwent head CT), head CT showed abnormalities, such as loss of gray-white differentiation, global cerebral edema, and ischemic stroke. The authors note that head CT findings led to changes in management in 15 patients. These changes included transfer to the neurological intensive care unit, repeat head CT, and neurosurgical consultation alone; only one patient underwent neurological surgery. Of patients for whom CT findings changed management, only one survived, in a persistent vegetative state.
The limited clinical significance of the CT findings and of the resulting management changes does not make a compelling case to expand the use of CT scans. In patients stable enough for imaging, head CT should be obtained if pre-arrest symptoms or the neurological exam suggest a neurological source for the arrest or if the patient had significant head trauma.

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