Critical Care: Original Research
Diagnostic Yield of CT Imaging and Point-of-Care Ultrasound After In-Hospital Cardiac Arrest
Luke Andrea, Jack Galfund, Lewis A. Eisen, et al
Chest 2026; 170: 118-127
https://doi.org/10.1016/j.chest.2026.02.023
Abstract
Background
CT imaging and point-of-care ultrasound (POCUS) have demonstrated usefulness after out-of-hospital cardiac arrest (OHCA), but their diagnostic yield and impact after in-hospital cardiac arrest (IHCA) are unclear.
Research Question
Will CT and POCUS imaging identify acute pathologic features that change postarrest management after IHCA?
Study Design and Methods
This retrospective observational study at 4 hospitals included adults with IHCA who achieved return of spontaneous circulation (ROSC). Patients with OHCA, nonindex arrest, or do-not-resuscitate orders were excluded. CT and POCUS imaging performed within 48 hours of ROSC were reviewed for new findings and management changes. Additional exclusions for CT imaging analysis included death within 24 hours of ROSC.
Results
A total of 345 patients met inclusion criteria. The CT imaging cohort comprised 235 patients (68.1%), and 112 patients (47.7%) underwent CT imaging within 48 hours of ROSC. Head CT imaging was most common (89.3%), followed by CT imaging of the chest (57.1%), abdomen and pelvis (43.8%), and other regions (10.7%). CT imaging identified new findings in 65.2% of patients, which led to management changes in 65.8% of patients. CT imaging of the chest yielded the highest diagnostic usefulness, with new findings in 92.2% of patients and management changes in 64.1% of patients. The suspected cause of arrest was identified in 20.5% of CT scans. POCUS was performed in 264 patients (76.5%), most commonly cardiac (98.1%) and chest (70.8%) POCUS. New findings were identified in 57.6% of POCUS studies, and management changes resulted from 41.3% of POCUS images. POCUS identified the suspected arrest cause in 19.3% of patients. Only 1 adverse event occurred, a cardiac arrest during CT imaging (0.3% overall).
Table 2. Diagnostic Yield and Management Change Proportions for CT and POCUS Imaging in the First 48 Hours After ROSC
| Variable | Total | New Finding | Management Change |
|---|---|---|---|
| CT imaging results | |||
| Any scan | 112/235 (47.7) | 73/112 (65.2) | 48/73 (65.8) |
| Head | 100/235 (42.6) | 22/100 (22.0) | 17/22 (77.3) |
| Chest | 64/235 (27.2) | 54/64 (84.4) | 32/54 (59.3) |
| Abdomen and pelvis | 49/235 (20.9) | 27/49 (55.1) | 9/27 (33.3) |
| Other | 12/235 (5.1) | 2/12 (16.7) | 2/2 (100) |
| POCUS results | |||
| Any | 264/345 (76.5) | 152/264 (57.6) | 86/152 (56.6) |
| Chest | 187/345 (54.2) | 68/187 (36.4) | 40/68 (58.8) |
| Cardiac | 259/345 (75.1) | 99/259 (38.2) | 48/99 (48.5) |
| Abdomen | 80/345 (23.2) | 12/80 (15.0) | 6/12 (50.0) |
| Blood vessel | 79/345 (22.9) | 17/79 (21.5) | 13/17 (76.5) |
Table 3. Select CT Imaging Results
| Variable | Total | New Finding | Management Change |
|---|---|---|---|
| Head findings | |||
| Ischemic stroke | 21/100 (21.0) | 7/100 (7.0) | 4/100 (4.0) |
| Cerebral hypoxic or ischemic injury | 11/100 (11.0) | 11/100 (11.0) | 10/100 (11.0) |
| Chest findings | |||
| Pulmonary airspace opacities | 52/64 (81.3) | 37/64 (57.8) | 28/64 (43.5) |
| Simple pleural effusion | 33/64 (51.6) | 18/64 (28.1) | 2/64 (3.1) |
| Pneumothorax | 6/64 (9.4) | 3/64 (4.7) | 3/64 (4.7) |
| Pulmonary embolism | 6/64 (9.4) | 5/64 (7.8) | 3/64 (4.7) |
| Endotracheal tube misplacement | 6/64 (9.4) | 6/64 (9.4) | 6/64 (9.4) |
| Catheter misplacement | 2/64 (3.1) | 2/64 (3.1) | 2/64 (3.1) |
| Rib fracture | 17/64 (26.6) | 17/64 (26.6) | 0 (0.0) |
| Abdomen or pelvis findings | |||
| Intraabdominal hemorrhage | 1/49 (2.0) | 1/49 (2.0) | 1/49 (2.0) |
| Retroperitoneal hemorrhage | 1/49 (2.0) | 1/49 (2.0) | 1/49 (2.0) |
| Ischemic colitis or enteritis | 5/49 (10.2) | 5/49 (10.2) | 2/49 (4.1) |
| Other findings | |||
| Vessel (nonpulmonary) thromboembolism | 1/12 (8.3) | 0/12 (0.0) | 0/12 (0.0) |
Table 4. Select Ultrasound Imaging Results
| Variable | Total | New Finding | Management Change |
|---|---|---|---|
| Chest findings | |||
| B lines | 88/187 (47.1) | 46/187 (24.6) | 35/187 (18.7) |
| Absent lung sliding | 4/187 (2.1) | 3/187 (1.6) | 3/187 (1.6) |
| Pleural effusion, simple | 53/187 (28.3) | 12/187 (6.4) | 10/187 (5.4) |
| Consolidation, static air bronchograms | 29/187 (15.5) | 17/187 (9.1) | 11/187 (5.9) |
| Cardiac findings | |||
| Reduced right ventricle function | 87/259 (33.6) | 38/259 (14.7) | 19/259 (7.3) |
| Reduced left ventricle function | 106/259 (40.9) | 52/259 (20.1) | 32/259 (12.4) |
| Pericardial effusion with tamponade | 2/259 (0.8) | 0/259 (0.0) | 2/259 (0.8) |
| Echogenic material within heart | 4/259 (1.5) | 3/259 (1.2) | 3/259 (1.2) |
| Abdomen findings | |||
| Intraabdominal fluid | 28/80 (35.0) | 9/80 (11.3) | 6/80 (7.5) |
| Vessel findings | |||
| Deep vein thrombosis | 10/79 (12.7) | 9/79 (11.4) | 7/79 (8.9) |
| Arterial thrombosis | 9/79 (11.4) | 8/79 (10.1) | 6/79 (7.6) |
Interpretation
Our results show that among survivors of IHCA, CT imaging and POCUS frequently identified new pathologic features, including suspected arrest causes, with subsequent management changes in a substantial proportion of patients. Chest CT imaging demonstrated particularly high diagnostic yield, whereas POCUS provided timely bedside information. Both methods seem valuable in the early post-ROSC period, with rare but notable risks during CT imaging transport.
