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REBEL Cast Ep119: A Discussion with Scott Weingart on the CT FIRST Trial

By Marco Torres June 29, 2023 0 comments

Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC?.  This stemmed a lot of discussion in the background between Swami, myself, and Scott.  We felt it was worthwhile to record this as a podcast to better flush out some nuanced points. Below you will find some of the points we discussed.

REBEL Cast Ep119:  A Discussion with Scott Weingart on the CT FIRST Trial

  1. Timing
    • Is 6hrs reasonable because most pts excluded because of this
    • Right before heading up to ICU seems good
    • 1st couple hours after ROSC…pts are high risk for re-coding
  1. Where
    • Not single coverage or stand-alone EDs
    • Optimize and transfer…scans can be done at bigger facility (Like trauma patients)
  1. CCTA
    • Anatomical study…not functional study
    • Even if lesion seen…will cards say wait 24 to 48hrs for neuroprognostication
    • Without beta blocker and nitro…CCTA suboptimal…authors say as much in paper
    • What type of scanner do you have at your institution? 160slice scanner, 320 slice scanner etc…
  1. If already going to the scanner…
    • If taking a trip to scanner need it to be high yield
    • Might as well go ahead and do the chest/abdomen/pelvis as well
    • Lots of patients have injuries secondary to CPR itself
  1. What is meant by pan-scan in cardiac arrest
    • Non-con head CT
    • CCTA chest
    • Abd/Pelvis without venous phase
  1. Diagnosing more things, but no difference in mortality
    • Mortality secondary outcome in a diagnostic study, not a treatment study
    • Not a surprise that there was no mortality benefit
    • Not all cardiac arrest is created equal
    • No information on early arrest factors (Time down, witnessed arrest, bystander CPR, initial rhythm, arrival pH, arrival lactate, pre-arrest functional status, etc…)

References:

  1. Swaminathan A. The CT FIRST Trial: Should We Pan-CT After ROSC?, REBEL EM Blog, June 1, 2023. Available at: HERE
  2. Branch KHR et al. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Resus 2023. PMID: 37019352

Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami)

The post REBEL Cast Ep119: A Discussion with Scott Weingart on the CT FIRST Trial appeared first on REBEL EM - Emergency Medicine Blog.


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