Written by Jason Lesnick
Spoon Feed
Of patients with return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), CT imaging revealed new findings 65.2% of the time while POCUS did so in 57.6% of IHCA patients.
Post-ROSC IHCA imaging follows the 80/20 rule
This retrospective observational cohort study examined the diagnostic yield and clinical management changes with CT and POCUS following IHCA with ROSC.
The authors analyzed data of 345 adult patients (ROSC at least 20 minutes) across four hospitals from 2022-2024 who had either CT or POCUS within 48 hours of ROSC after IHCA. They analyzed rates of new findings on imaging by type of imaging, if cause of arrest was identified, and for subsequent treatment changes.
CT identified new abnormalities in 65.2% of scans; of those, 65.8% led to changes in management. CT of the chest had the highest rate of new findings (92.2%) while CT of the head identified new findings in 25.0% of patients.
POCUS identified new findings in 57.6% of patients, and 56.6% of those resulted in changes in management. Chest and cardiac POCUS revealed new findings in 36.4% and 38.2% of patients, respectively.
Etiology of arrest was identified in 20.5% of the CT scanned group and 19.3% of the POCUS group.
How will this change my practice?
In this cohort, only 1 (0.3%) patient experienced the most dreaded adverse event – cardiac arrest in the CT scanner. We know imaging after out of hospital cardiac arrest is often a valuable tool (see here, here, and here), and these data provide some interesting context regarding the expected utility of these diagnostic studies for IHCA. I’ll continue to image these patients liberally.
Source
Diagnostic Yield of Computed Tomography and Point-of-Care Ultrasound After In-Hospital Cardiac Arrest. Chest. 2026 Mar 13:S0012-3692(26)00297-7. doi: 10.1016/j.chest.2026.02.023. Epub ahead of print. PMID: 41833810.
