Lit Matters #1: Should We be Doing a Brain CT in patients with ROSC after OHCA?

Out-of-hospital cardiac arrest with ROSC is usually cardiac in origin, and routine brain CT rarely changes management when no clear neurologic cause is apparent. Post-arrest imaging still matters when the etiology is unclear, especially when intracranial hemorrhage or another occult neurologic trigger would redirect care.

Brain CT After OHCA ROSC

• Predominantly cardiac etiology: Most OHCA cases are driven by cardiac causes, so a routine head CT after ROSC has a relatively low yield unless the history, exam, or arrest context points toward a neurologic trigger.
• Clinically significant CT yield: In this prospective cohort, clinically significant brain CT findings appeared in 12% of scanned patients, with acute ischemia more common than hemorrhage, mass, edema, or herniation.
• Normal scan frequency: Nearly half of post-ROSC head CTs were normal, a useful reminder that universal imaging consumes substantial resources in a population already difficult to move and stabilize.
• Management change definition: The study counted pathology as significant only when it changed treatment, but that endpoint is inherently subjective and leaves room for wide physician-level variation in what action follows a finding.
• Outcome implications: Patients with acute intracranial pathology after OHCA had poor outcomes, and mortality was similar between groups, which complicates the assumption that finding an abnormality necessarily improves prognosis.
• Selective imaging strategy: A reasonable approach is to reserve brain CT for patients without a clear arrest cause or with neurologic red flags, and we get into that post-ROSC decision tension in the episode.