Etiology of out-of-hospital cardiac arrest diagnosed via detailed examinations including perimortem computed tomography

• Published in: Journal of emergencies, trauma and shock Vol. 6; no. 2; pp. 87 - 94
• Main Authors: Moriwaki, Yoshihiro, Tahara, Yoshio, Kosuge, Takayuki, Suzuki, Noriyuki
• Format: Journal Article
• Language: English
• Published: India Medknow Publications 01.04.2013; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Abdomen; Airway management; Cardiac arrest; Causes and theories of causation; CT imaging; Diagnosis; Diseases; Emergency service; Etiology of out-of-hospital cardiac arrest; Hospitals; Intubation; Medical imaging; Original; out-of-hospital cardiac arrest with non-cardiac etiology; perimortem computed tomography; perimortem imaging; Risk factors; Tomography; Japan; perimortem computed tomography; out-of-hospital cardiac arrest with non-cardiac etiology; perimortem imaging; Etiology of out-of-hospital cardiac arrest
• ISSN: 0974-2700; 0974-519X
• DOI: 10.4103/0974-2700.110752

Context: The spectrum of the etiology of out-of-hospital cardiopulmonary arrest (OHCPA) has not been established. We have performed perimortem computed tomography (CT) during cardiopulmonary resuscitation. Aims: To clarify the incidence of non-cardiac etiology (NCE), actual distribution of the causes of OHCPA via perimortem CT and its usefulness. Settings and Design: Population-based observational case series study. Materials and Methods: We reviewed the medical records of 1846 consecutive OHCPA cases and divided them into two groups: 370 showing an obvious cause of OHCPA with NCE (trauma, neck hanging, terminal stage of malignancy, and gastrointestinal bleeding) and others. Results: Of a total OHCPA, perimortem CT was performed in 57.5% and 62.5% were finally diagnosed as NCE: Acute aortic dissection (AAD) 8.07%, pulmonary thrombo-embolization (PTE) 1.46%, hypoxia due to pneumonia 5.25%, asthma and acute worsening of chronic obstructive pulmonary disease 2.06%, cerebrovascular disorder (CVD) 4.48%, airway obstruction 7.64%, and submersion 5.63%. The rates of patients who survived to hospital discharge were 6-14% in patients with NCE. Out of the 1476 cases excluding obvious NCE of OHCPA, 66.3% underwent perimortem CT, 14.6% of cases without obvious NCE and 22.1% of cases with perimortem CT were confirmed as having some NCE. Conclusions: Of the total OHCPA the incidences of NCE was 62.5%; the leading etiologies were AAD, airway obstruction, submersion, hypoxia and CVD. The rates of cases converted from cardiac etiology to NCE using perimortem CT were 14.6% of cases without an obvious NCE.