Within ED we often have little information about the patient we are resuscitating. Post-ROSC (return of spontaneous circulation )we commonly perform CT head, but evidence and Resus Council Guidance suggests extending this scan can pick up important pathology that can otherwise be missed (13%).

Inclusion Criteria (ALL)

• ROSC – From OOH arrest or early arrest in ED
• No ‘CLEAR’ Cause – e.g. STEMI, Hanging, overdose (which would need emergent treatment or different scan regime)
• For Full & Active Management
• No Contrast Allergy

Scan (Order)

• CT Head
• CTPA
• CT Abdo/Pelvis

Timing

• During a period of stability – decided clinically by ED/ICU (will be escorted)
• Ideally within 6Hrs of ROSC
• Should NOT delay time critical treatments or transfer to destination ward

Practicalities

• Referral can be made direct to radiographer if:
  • MG/Con – by ED/ICU/Med
  • Document – ‘Post ROSC ED CT Protocol, No Clear Cause, For full Active management, renal function will be treated’
• Green (18G) Cannula – or larger
• Transfer – will need medical transfer team (i.e. not just a nurse)
  • Likely from ED but no need to wait in ED , can happen on way/from ward/ICU
• eGFR – not needed prior (as will be treated anyway)

References:

• Early head-to-pelvis computed tomography in out-of-hospital circulatory arrest without obvious etiology

• Early whole-body CT for treatment guidance in patients with return of spontaneous circulation after cardiac arrest
• Resus Council – Post-resuscitation care Guidelines