Lit Matters #2: Should We do Head-to-Pelvis CT in OHCA?

Post-ROSC whole-body CT can uncover a time-critical cause of out-of-hospital cardiac arrest when the etiology is unclear, but the yield is far from universal. Early head-to-pelvis imaging appears safe in selected stable patients and is most compelling as a targeted rather than automatic post-arrest strategy.

Whole-Body CT After OHCA

• Targeted post-ROSC imaging: Whole-body CT is most useful after ROSC when out-of-hospital cardiac arrest has no obvious cause, especially for occult intracranial hemorrhage, pulmonary embolism, pneumonia, or abdominal catastrophe.
• Selective rather than routine use: The pragmatic takeaway is not to scan every post-arrest patient; hemodynamic instability and an obvious cath-lab pathway still trump a protocolized head-to-pelvis CT. We get into that bedside triage in the episode.
• Meaningful diagnostic yield: Early sudden-death CT identified the etiology of arrest only by imaging in 13% of cases, a modest number that still matters when the diagnosis is immediately management-changing.
• Time-critical findings detected: Among patients with urgent diagnoses, whole-body CT captured nearly all of them and missed only one, supporting its value as a screen for immediately actionable pathology.
• Safety signal in selected patients: Contrast exposure did not appear to trigger major downstream harm in this cohort; AKI was common after arrest, but only one patient ultimately required CRRT.
• Study design caveats: This was a 104-patient observational cohort with exclusions for unstable patients and those needing emergent catheterization, so the results support feasibility more than a universal protocol.