Lit Matters #3: Does a Pan Scan Yield More Diagnostic Accuracy in OHCA?

Whole-body CT after return of spontaneous circulation can find occult causes of out-of-hospital cardiac arrest faster, but faster diagnosis does not necessarily improve survival. In post-ROSC OHCA care, the practical question is not whether imaging matters, but which patients benefit from protocolized head-to-pelvis CT versus a selective, exam-driven approach.

Post-ROSC CT Imaging After OHCA

• Faster diagnosis, same survival: Protocolized head-to-pelvis CT shortened time to identified cause from 14 hours to 3 hours, yet survival to discharge stayed essentially unchanged between groups.
• Diagnostic yield signal: Finding a clear post-arrest cause in more than 10% of patients is clinically meaningful, especially when the differential includes hemorrhage, PE, aortic disease, or other noncoronary pathology.
• Selective imaging reality: Even standard care was not no-imaging care: 84% of patients underwent some imaging, with selective CT head doing much of the work in usual post-ROSC evaluation.
• Protocolized pan scan limits: A universal sudden-death CT pathway improved speed and diagnostic accuracy, but neurologically intact survival did not improve and actually numerically favored standard care.
• Bedside-first imaging strategy: Noncontrast head CT, targeted physical exam, and hypotension-focused POCUS remain the practical first pass before escalating to chest angiography or coronary CT in selected patients. We walk through that sequencing in the episode.
• Not ready for all comers: The take-home is that routine pan scan after OHCA with ROSC is not ready for primetime; imaging should be tailored with ICU input, local resources, and the suspected arrest mechanism.