Introduction

Out-of-hospital cardiac arrest (OHCA) caused by an ST-elevation myocardial infarction (STEMI) is often accompanied by a sudden loss of consciousness that may cause the patient to collapse with resulting head trauma, leading to a suspicion of possible intracranial haemorrhage. To rule out intracranial haemorrhage before emergency percutaneous coronary intervention (PCI), emergency computed tomography (CT) of the head might be useful but also causes a delay in percutaneous STEMI treatment.

Methods

The medical records of all adult patients that presented with OHCA to the emergency department (ED) of the University Medical Centre Utrecht (UMCU), the Netherlands between 16 February 2020 and 16 February 2022 were reviewed.

Results

A total of 263 patients presented to the ED with an OHCA; 50 presented with a STEMI requiring emergency PCI. Thirty-nine (78%) patients with a STEMI were immediately referred to the catheterisation laboratory and 11 (22%) STEMI patients underwent a CT scan prior to emergency angiography; in no case was PCI deferred on the basis of the CT findings. The dominant indication for CT of the head was collapse, reported by 10 patients and resulting in a visible traumatic head injury in 7 patients. In none of the patients was intracranial haemorrhage detected. However, there was a delay between presentation to the ED and arrival at the catheterisation laboratory in patients who underwent CT of the head (mean 63 ± 25 min) before emergency PCI compared to patients without a CT scan (mean 37 ± 21 min).

Conclusion

CT of the head did not result in a diagnosis of intracranial haemorrhage or deferral of PCI but did delay PCI treatment for STEMI in patients presenting with OHCA.

中文翻译：

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计算机断层扫描对急诊经皮冠状动脉介入治疗前院外心脏骤停患者头部外伤的价值

介绍

由 ST 段抬高型心肌梗塞 (STEMI) 引起的院外心脏骤停 (OHCA) 通常伴有意识突然丧失，可能导致患者昏倒并导致头部外伤，从而怀疑可能存在颅内出血。为了在紧急经皮冠状动脉介入治疗 (PCI) 之前排除颅内出血，头部的紧急计算机断层扫描 (CT) 可能有用，但也会导致经皮 STEMI 治疗的延迟。

方法

对 2020 年 2 月 16 日至 2022 年 2 月 16 日期间到荷兰乌得勒支大学医学中心 (UMCU) 急诊科 (ED) 就诊的所有 OHCA 成年患者的医疗记录进行了审查。

结果

共有 263 名患者因 OHCA 向急诊科就诊；50 人出现 STEMI，需要紧急 PCI。39 名 (78%) 的 STEMI 患者被立即转至导管插入实验室，11 名 (22%) 的 STEMI 患者在紧急血管造影前接受了 CT 扫描；没有任何病例因 CT 检查结果而推迟 PCI。头部 CT 的主要指征是塌陷，有 10 名患者报告，导致 7 名患者出现明显的头部外伤。所有患者均未发现颅内出血。然而，与未接受 CT 扫描的患者（平均 37 ± 21 分钟）相比，在急诊 PCI 前接受头部 CT 治疗的患者（平均 63 ± 25 分钟）从到急诊科就诊到到达导管实验室之间存在延迟。

结论

头部 CT 并未导致颅内出血的诊断或推迟 PCI，但确实延迟了 OHCA 患者的 STEMI 的 PCI 治疗。