Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study

Resuscitation. 2023 Jul:188:109785. doi: 10.1016/j.resuscitation.2023.109785. Epub 2023 Apr 3.


Aim: Our aim was to test whether a head-to-pelvis CT scan improves diagnostic yield and speed to identify causes for out of hospital circulatory arrest (OHCA).

Methods: CT FIRST was a prospective observational pre-/post-cohort study of patients successfully resuscitated from OHCA. Inclusion criteria included unknown cause for arrest, age >18 years, stability to undergo CT, and no known cardiomyopathy or obstructive coronary artery disease. A head-to-pelvis sudden death CT (SDCT) scan within 6 hours of hospital arrival was added to the standard of care for patients resuscitated from OHCA (post-cohort) and compared to standard of care (SOC) alone (pre-cohort). The primary outcome was SDCT diagnostic yield. Secondary outcomes included time to identifying OHCA cause and time-critical diagnoses, SDCT safety, and survival to hospital discharge.

Results: Baseline characteristics between the SDCT (N = 104) and the SOC (N = 143) cohorts were similar. CT scans (either head, chest, and/or abdomen) were ordered in 74 (52%) of SOC patients. Adding SDCT scanning identified 92% of causes for arrest compared to 75% (SOC-cohort; p value < 0.001) and reduced the time to diagnosis by 78% (SDCT 3.1 hours, SOC alone 14.1 hours, p < 0.0001). Identification of critical diagnoses was similar between cohorts, but SDCT reduced delayed (>6 hours) identification of critical diagnoses by 81% (p < 0.001). SDCT safety endpoints were similar including acute kidney injury. Patient survival to discharge was similar between cohorts.

Discussion: SDCT scanning early after OHCA resuscitation safely improved the efficiency and diagnostic yield for causes of arrest compared to the standard of care alone.

Clinical trials number: NCT03111043.

Keywords: Abdominopelvic computed tomography; Acute kidney injury; Cardiac computed tomography; Cohort study; Diagnostic testing; Head computed tomography; Out of hospital cardiac arrest; Resuscitation; Standard of care.

Publication types

  • Observational Study

MeSH terms

  • Abdomen
  • Adolescent
  • Cardiopulmonary Resuscitation* / adverse effects
  • Cardiopulmonary Resuscitation* / methods
  • Cohort Studies
  • Death, Sudden
  • Humans
  • Out-of-Hospital Cardiac Arrest*
  • Pelvis / diagnostic imaging
  • Tomography, X-Ray Computed / methods

Associated data

  • ClinicalTrials.gov/NCT03111043