Clinical Significance of Whole-Body Computed Tomography Scans in Pediatric Out-of-Hospital Cardiac Arrest Patients Without Prehospital Return of Spontaneous Circulation

Abstract

Background. Whole-body computed tomography (WBCT) is commonly employed for primary screening in pediatric patients experiencing out-of-hospital cardiac arrest (OHCA) without prehospital return of spontaneous circulation (ROSC). This study aimed to evaluate the cause of OHCA on WBCT and compare WBCT findings between ROSC and non-ROSC groups in non-traumatic pediatric OHCA cases in an emergency department setting. Methods. A retrospective analysis was conducted on 27 pediatric patients (mean age: 32.4 months; median age: 10 months) who experienced non-traumatic OHCA without prehospital ROSC and were transported to our tertiary care hospital between January 2013 and December 2023. WBCT scans were performed to investigate the cause of OHCA, with recorded findings in the head, chest, abdomen, and subcutaneous tissues. Results. In all cases, the direct causes of OHCA were undetermined, and WBCT identified no fatal findings. Statistical comparisons of CT findings between the ROSC and non-ROSC groups revealed significant differences. The non-ROSC group had a higher incidence of brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic walls, narrowed aorta, gas in the mediastinum, and hepatomegaly compared to the ROSC group. Conclusions. Although WBCT did not reveal the direct cause of OHCA, several CT findings were significantly more frequent in the non-ROSC group, including brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic wall, narrowed aorta, gas in the mediastinum, and hepatomegaly. These findings, resembling postmortem changes, may aid in clinical decision making regarding the continuation or cessation of resuscitation efforts in pediatric OHCA cases.

Keywords: computed tomography; out-of-hospital cardiac arrest; pediatric patient; return of spontaneous circulation.

Figure 1

Nine-month-old boy with non-ROSC (case No. 19 in Table S1). (a) Observations in the head included brain swelling, loss of cerebral gray-white matter differentiation, and hyperdense intracranial venous sinus (arrows). (b) Symmetrical consolidation/ground-glass opacity of the lungs was noted. (c) In the mediastinum, findings included cardiomegaly, a hyperdense aortic wall (arrows), and gas in the cardiac cavity (arrowheads). (d) A narrowed aorta (arrow) and hepatomegaly were observed.

Figure 1

Nine-month-old boy with non-ROSC (case No. 19 in Table S1). (a) Observations in the head included brain swelling, loss of cerebral gray-white matter differentiation, and hyperdense intracranial venous sinus (arrows). (b) Symmetrical consolidation/ground-glass opacity of the lungs was noted. (c) In the mediastinum, findings included cardiomegaly, a hyperdense aortic wall (arrows), and gas in the cardiac cavity (arrowheads). (d) A narrowed aorta (arrow) and hepatomegaly were observed.

Figure 2

Four-month-old boy with ROSC (case No. 6 in Table S2). (a) No symmetrical or asymmetrical lung consolidation/ground-glass opacity of the lungs was observed. (b) In the mediastinum, mild cardiomegaly was noted, but no hyperdense aortic wall was identified. (c) A dilated gastrointestinal tract was observed.