Applying the algorithm for use of coronary angiography and chest and head computed tomography resulted in a diagnosis for nearly 60% of patients.

Although out-of-hospital cardiac arrest (OHCA) is a common mode of death, the medical response is individualized, with few standardized protocols other than for therapeutic hypothermia. A Parisian hospital developed a protocol for diagnostic imaging of all OHCA cases, and these authors reviewed 10 years of experience with it.

The protocol involves first excluding patients who have an obvious cause of OHCA, such as trauma or drowning, or are too unstable for catheterization or computed tomography (CT) scanning. Then, for patients with return of spontaneous circulation, the protocol indicates CT scanning of the chest and brain if there were neurological or respiratory symptoms before the arrest and percutaneous coronary angiography (PTCA) if there were no such symptoms. If no culprit lesion is found, the other diagnostic study is performed.

The study included 896 patients without obvious cause of OHCA. PTCA was performed in 745 patients and identified a culprit lesion in 452 (61%). CT of the brain and pulmonary arteries was performed in 355 patients and provided a diagnosis in 72 (20%) — stroke in 11% and pulmonary embolism in 9%.

CITATION(S):

Chelly J et al. Benefit of an early and systematic imaging procedure after cardiac arrest: Insights from the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) registry. Resuscitation 2012 Dec; 83:1444.