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

Yoshihiro Moriwaki, Yoshio Tahara, Takayuki Kosuge, Noriyuki Suzuki, Yoshihiro Moriwaki, Yoshio Tahara, Takayuki Kosuge, Noriyuki Suzuki

Abstract

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.

Keywords: Etiology of out-of-hospital cardiac arrest; out-of-hospital cardiac arrest with non-cardiac etiology; perimortem computed tomography; perimortem imaging.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Map of Yokohama city indicating the 12 hospitals to which the emergency medical service system transfers out-of-hospital cardiopulmonary arrest (OHCPA) patients based on the nearest emergency department and which must receive OHCPA patients. For each hospital in Yokohama including our hospital, all data concerning cardiopulmonary arrest patients are population-based
Figure 2
Figure 2
Standard and optional advanced examination and evaluation of out-of-hospital cardiopulmonary arrest patients in our emergency department
Figure 3
Figure 3
The relation of out-of-hospital cardiopulmonary arrest patients and the performance of perimortem computed tomography

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