Benefit of an early and systematic imaging procedure after cardiac arrest: Insights from the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) registry |
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Authors: | Jonathan Chelly Nicolas Mongardon Florence Dumas Olivier Varenne Christian Spaulding Olivier Vignaux Pierre Carli Julien Charpentier Frédéric Pène Jean-Daniel Chiche Jean-Paul Mira Alain Cariou |
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Institution: | 1. Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France;2. Emergency Department, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 1 Place du Parvis Notre-Dame, 75004 Paris, France;3. Department of Cardiology, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France;4. Department of Radiology, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France;5. SAMU 75, Necker Hospital, Assistance Publique des Hôpitaux de Paris, 161 rue de Sèvres, 75015 Paris, France;6. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 15 rue de l’Ecole de Médecine, 75006 Paris, France;g INSERM U970, Cardiovascular Research Center, European Georges Pompidou Hospital, 56 Rue Leblanc, 75015 Paris, France |
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Abstract: | AimsIdentification of the cause of out-of-hospital cardiac arrest (OHCA) is of paramount importance. We investigated the ability of our imaging strategy to provide an early etiological diagnosis of OHCA and the influence of this strategy on ICU survival.MethodsRetrospective review of a prospectively acquired ICU database (01/2000–12/2010) including all OHCA patients without obvious extracardiac cause, for which an early diagnosis research was conducted (coronary angiography and/or brain and chest CT scan) within 24 h after resuscitation. These procedures could be performed separately or be combined, according to a decision algorithm.ResultsOf the 1274 patients admitted after OHCA during this 10-year period, the imaging strategy was applied in 896 patients. Patients who benefited from coronary angiography and/or CT scan were admitted to our ICU after a median delay of 180 130–220] min after resuscitation. Seven hundred and forty-five coronary angiographies were performed, of which 452 (61%) identified at least one significant coronary lesion deemed responsible for the OHCA. CT-scan was performed in 355 patients and provided a diagnosis in 72 patients (20%), mainly stroke (n = 38) and pulmonary embolism (n = 19). Overall, this strategy allowed early diagnosis in 524 patients (59%). ICU survival was significantly higher for patients with a diagnosis identified by coronary angiography as compared with CT-scan (43% vs 10%, p < 0.001).ConclusionThe use of an early diagnosis protocol with immediate coronary angiography and/or CT scan provided the etiology of nearly two thirds of OHCA cases. In this large retrospective database, coronary angiography yielded a better diagnostic value than brain and/or chest CT-scan. |
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Keywords: | Cardiac arrest Diagnosis CT-Scan Coronary angiography Outcome |
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