Abstract Body: Introduction: Head-to-pelvis sudden death computed tomography (SDCT) protocol has a high diagnostic yield for causes and complications of out-of-hospital cardiac/circulatory arrest (OHCA). While a gold standard of morbidity and causes of mortality has been autopsy examination, comparative analysis of SDCT has not been explored.
Methods: Study patients were those resuscitated from OHCA between December 2015 and August 2019 who received 1) SDCT (non-contrast head CT, ECG-gated chest CT, and non-ECG gated venous phase abdominopelvic CT) within 6 hours of hospital arrival and 2) autopsy examination after death. Findings from SDCT readings blinded to autopsy and clinical pathology reports were tabulated. The primary outcome was differences in neural, chest-vascular, pulmonary, and gastrointestinal diagnoses between SDCT and autopsy reports.
Results: Thirty one patients were included in this prospective cohort whose major clinical findings are reported in the Table. SDCT was performed at a median of 2.4 (IQR 2.1,3.2) hours from OHCA event and death occurred at a median of 2.2 (IQR 1.0,4.7) days. There were 82 clinically important SDCT and 52 autopsy findings with 45 diagnostic discrepancies between the two. Organ procurement caused 5 discrepancies. The most common discrepancies identified by SDCT but not autopsy were pneumothorax, pneumonia, and sternal/rib fractures. Discrepancies identified by autopsy but not SDCT were mostly related to cerebral bleeding and infarction.
Conclusions: Both concordant and discrepant findings were observed between autopsy and early head-to-pelvis CT after initial resuscitation from OHCA, potentially due to differences in time and treatment between the SDCT and death. These results suggest complementary roles of pre-mortem imaging as well as post-mortem examination to identify important abnormalities after a resuscitated OHCA event.