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
- Timing
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- 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
- Where
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- Not single coverage or stand-alone EDs
- Optimize and transfer…scans can be done at bigger facility (Like trauma patients)
- CCTA
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- 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…
- If already going to the scanner…
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- 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
- What is meant by pan-scan in cardiac arrest
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- Non-con head CT
- CCTA chest
- Abd/Pelvis without venous phase
- Diagnosing more things, but no difference in mortality
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- 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:
- Swaminathan A. The CT FIRST Trial: Should We Pan-CT After ROSC?, REBEL EM Blog, June 1, 2023. Available at: HERE
- 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.