REBEL Cast Ep119: A Discussion with Scott Weingart on the CT FIRST Trial

Back on June 1^st, 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

1. Timing

• • 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

2. Where

• • Not single coverage or stand-alone EDs
  • Optimize and transfer…scans can be done at bigger facility (Like trauma patients)

3. CCTA

• • 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…

4. If already going to the scanner…

• • 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

5. What is meant by pan-scan in cardiac arrest

• • Non-con head CT
  • CCTA chest
  • Abd/Pelvis without venous phase

6. Diagnosing more things, but no difference in mortality

• • 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:

1. Swaminathan A. The CT FIRST Trial: Should We Pan-CT After ROSC?, REBEL EM Blog, June 1, 2023. Available at: HERE
2. 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)