Cervical spinal cord injury by a low-impact trauma as an unnoticed cause of cardiorespiratory arrest

Diagnostic yield of computed tomography after non-traumatic out-of-hospital cardiac arrest

AIM

Determine the frequency with which computed tomography (CT) after out-of-hospital cardiac arrest (OHCA) identifies clinically important findings.

METHODS

We included non-traumatic OHCA patients treated at a single center from February 2019 to February 2021. Clinical practice was to obtain CT head in comatose patients. Additionally, CT of the cervical spine, chest, abdomen, and pelvis were obtained if clinically indicated. We identified CT imaging obtained within 24 hours of emergency department (ED) arrival and summarized radiology findings. We used descriptive statistics to summarize population characteristics and imaging results, report their frequencies and, post hoc, compared time from ED arrival to catheterization between patients who did and did not undergo CT.

RESULTS

We included 597 subjects, of which 491 (82.2%) had a CT obtained. Time to CT was 4.1 hours [2.8-5.7]. Most (n = 480, 80.4%) underwent CT head, of which 36 (7.5%) had intracranial hemorrhage and 161 (33.5%) had cerebral edema. Fewer subjects (230, 38.5%) underwent a cervical spine CT, and 4 (1.7%) had acute vertebral fractures. Most subjects (410, 68.7%) underwent a chest CT, and abdomen and pelvis CT (363, 60.8%). Chest CT abnormalities included rib or sternal fractures (227, 55.4%), pneumothorax (27, 6.6%), aspiration or pneumonia (309, 75.4%), mediastinal hematoma (18, 4.4%) and pulmonary embolism (6, 3.7%). Significant abdomen and pelvis findings were bowel ischemia (24, 6.6%) and solid organ laceration (7, 1.9%). Most subjects that had CT imaging deferred were awake and had shorter time to catheterization.

CONCLUSIONS

CT identifies clinically important pathology after OHCA.

Analysis of autopsy cases involving individuals who experienced cardiopulmonary arrest immediately after sustaining minor head injuries

The authors report five forensic autopsy cases involving individuals who experienced cardiopulmonary arrest immediately after sustaining minor head injuries. Heartbeat was restored in two patients after resuscitation by paramedics. During autopsy, three patients exhibited high blood alcohol levels indicating severe intoxication, two had an unknown blood alcohol status, and all five exhibited parietal bruising of the head. In addition to alcohol intoxication, blunt force impact to the parietal area of the head was believed to be related to the occurrence of cardiopulmonary arrest immediately after head trauma. The absence of secondary brain damage in patients who die from cardiopulmonary arrest immediately after head trauma should be taken into account when diagnosing the cause of death. Additionally, indications for bystander cardiopulmonary resuscitation should be considered for individuals who experience cardiopulmonary arrest due to head trauma.

Cardiac asystole following high spinal cord injury: a case report

Cardiac asystole following cervical spine injury is rare and occurs after approximately 15-16% of cases of high spinal cord injury. While incidence of cardiac abnormalities after high spinal cord injury typically peak at 4-7 days following the initial injury, they have been reported to take up to 2-6 weeks to resolve. In our case the patient was found unresponsive in the field with pulseless cardiac activity. She had return of spontaneous circulation after a short period of cardiopulmonary resuscitation (CPR) and was transferred to the trauma intensive care unit (ICU) where she developed progressive motor and sensory deficits and was found to have anterior subluxation of C2 and C3 as well as fractures of the C2 and C3 vertebrae that were treated with decompression and C1-5 fusion. She has done well post-operatively and has had no further cardiac abnormalities since the time of her initial injury. The authors believe that patients that experience cardiac asystole secondary to high spinal cord injury who have rapid recovery of cardiac function can be managed with appropriate monitoring without medical management with inotropic agents or cardiac pacemaker implantation, and surgery to address neurologic deficits should not be delayed.