The Effect of Cranial Computed Tomography Results on Care Withdrawal Decisions After Out‐of‐Hospital Cardiac Arrest

Background:

Care following cardiac arrest includes therapy to support the patient as well as identification of the cause of arrest. It is unclear whether or not a screening cranial computed tomography (CT scan) is necessary in the immediate post‐arrest period as there are no guideline recommendations for the use of such testing. We examined whether findings on cranial CT scan factored into early care decisions.

Methods:

We studied 202 out‐of‐hospital, non traumatic, cardiac arrest survivors and analyzed patients who had Cranial CT imaging performed within 72 hours of admission. Grossly abnormal results were defined as severe diffuse brain edema, herniation or bleeding. Demographics, cardiac arrest characteristics and hospital care were studied in patients with and without abnormal CT finding using Chi square and t test. Logistic regression was used to identify the impact of abnormal cranial CT findings on early care withdrawal.

Results:

Of 202 patients studied, 137 had CT imaging performed (67%). Of these 112 patients (82%) had an unremarkable cranial CT (group1) whereas 25 patients (18%) had abnormal cranial CT findings as described above (group2). Mean age for patients receiving a cranial CT scan was 61 years (SD±15). Patients with unremarkable head CT findings (group1) were more likely to have a witnessed arrest as compared to patients with abnormal head CT (group2), (67% vs. 40%, p=0.03). Other patient characteristics were not significantly different between the two groups. The incidence of seizures was also comparable in both groups (PNS). An abnormal head CT prompted more family meetings (79% in group 2 vs. 56%in group 1, p=0.03), further neurological evaluation (84% in group 2 vs. 35% in group 1, p<0.001), but did not result in early care withdrawal (within 72 hours of admission) as compared to those with an unremarkable study [OR=1.2 95% CI (0.4‐3) P=0.64].

Conclusions:

Cranial CT scans are commonly performed post arrest but few are abnormal. Although performed, the results of such expensive testing do not appear to factor into, decisions on whether to continue life‐supporting therapy or withdraw care. More studies are needed to identify the indications and impact of cranial CT on management of resuscitated patients with cardiac arrest, so that expensive resources, such as this can be wisely allocated.