Use of whole body CT to detect patterns of CPR-related injuries after sudden cardiac arrest

Eur Radiol. 2018 Oct;28(10):4122-4127. doi: 10.1007/s00330-017-5117-0. Epub 2017 Nov 9.


Aims and objectives: We have recently implemented a dedicated sudden cardiac arrest (SCA) - whole-body computed tomography (WBCT) protocol to evaluate SCA patients with return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR). The aim of this study is to evaluate the number and pattern of CPR-related injuries in ROSC patients with SCA-WBCT.

Methods and materials: Single-centre retrospective review of 39 patients (13 female; 20 male, mean age 51.8 years) with non-traumatic, out-of-hospital SCA and ROSC and evaluation with dedicated SCA-WBCT over a 10-month period.

Results: In-hospital mortality was 54%. CPR-related injuries were detected in 85% (33/39). Chest injuries were most common on WBCT: 85% (33) subjects had rib fractures (mean of 8.5 fractures/subject); 31% (12) sternal fractures; 13% (5) mediastinal haematoma; 10% (4) pneumothorax; 8% (3) pneumomediastinum and 3% (1) haemothorax. Three subjects (8%) had abdominal injuries on WBCT, including one hepatic haematoma with active haemorrhage.

Conclusion: CPR-related injuries on WBCT after ROSC are common, with serial rib fractures detected most commonly. An unexpectedly high rate of abdominal injuries was detected on SCA-WBCT. Radiologists need to be attuned to the spectrum of CPR-related injuries in WBCT, including abdominal injuries and subtle rib fractures.

Key points: • CPR frequently causes injuries. • Radiologists should be aware of the spectrum of CPR related injuries. • Rib fractures are frequent and radiologic findings often subtle. • Clinically unexpected abdominal injuries may be present.

Keywords: Cardiopulmonary resuscitation; Emergencies; Radiology; Tomography, X-Ray computed; Wounds and injuries.

MeSH terms

  • Abdominal Injuries / diagnostic imaging*
  • Adult
  • Aged
  • Cardiopulmonary Resuscitation / adverse effects*
  • Death, Sudden, Cardiac*
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Retrospective Studies
  • Rib Fractures / diagnostic imaging
  • Thoracic Injuries / diagnostic imaging*
  • Tomography, X-Ray Computed / methods*
  • Young Adult