Head-to-pelvis Computed Tomography Evaluation of Sudden Death Survivors

Best practices for survivors of out-of-hospital sudden death are underdeveloped and untested.
Early diagnosis in sudden death survivors is challenging due to patient intubation and
obtundation, limited history, and imprecise standard of care testing. Sudden death without an
obvious cause (termed "idiopathic sudden death") is primarily caused by cardiovascular
disease although a large number of cases result from non-cardiac disease. Improvements in
computed tomography (CT) technologies provides a means to identify up to 86% of idiopathic
causes of sudden death, including cardiovascular and coronary artery disease, cerebral
disease, pulmonary embolism and abdominal catastrophe4 as well as secondary injury from
cardiopulmonary resuscitation. To date, use of early CT scans on consecutive sudden death
survivors has not been reported. The innovation of this pilot trial is to be first to test
whether a comprehensive head-to-pelvis, ECG-gated contrast CT scan (CT-First) can identify
the majority of causes for idiopathic sudden death. The significance of CT-First approach is
potentially reducing diagnostic errors, treatment delays and inappropriate treatments to
potentially improve clinical outcomes in this very high risk population. The expertise of the
medical centers involved, combined with the highly respected Medic One service, provide an
unusual opportunity to test this diagnostic paradigm with cutting edge CT technologies. The
data generated from this study will be used to plan larger randomized trials of early
contrast CT scanning versus invasive coronary angiography in sudden death survivors and may
be extrapolated to other patient populations such as possible acute coronary syndrome or
after trauma.

Inclusion Criteria:

1. Patients reaching the Emergency Department within 6 hours of resuscitated sudden
death.

2. No obvious cause for sudden death event with initial standard of care clinical
evaluation

3. Clinically stable to have CT performed per treating physician

4. Candidates for continued intubation and sedation during the CT scan with or without
therapeutic hypothermia protocol.

Exclusion Criteria:

1. Meets criteria for acute ST elevation myocardial infarction (ST elevation ≥1
contiguous lead or new or unknown duration left bundle branch block on ECG) or has
other indication for ICA

2. Obvious cause of sudden death - Examples: witnessed trauma, drowning, suicide attempt

3. Known non-revascularized coronary artery disease or coronary stent <2.5 mm.

4. Known severe renal dysfunction (eGFR<30 ml/hr, creatinine >1.7 mg/dl)

5. Implantable defibrillator, due to metal artifact from defibrillator coil

6. Known iodinated contrast allergy

7. Known hospice patient or terminal disease with expected <3 months survival