# CT Imaging Before Extracorporeal Cardiopulmonary Resuscitation in Hypothermic Cardiac Arrest With Trauma

## TL;DR

CT scans before resuscitation help decide if hypothermic cardiac arrest patients with trauma can benefit from prolonged treatment.

## Contribution

This paper presents two case reports demonstrating the use of CT imaging before ECPR in hypothermic cardiac arrest with trauma.

## Key findings

- CT imaging before ECPR revealed minor injuries in a 74-year-old male with successful neurological recovery.
- CT imaging in a 32-year-old female showed no major trauma, and she also had full neurological recovery after ECPR.
- CT imaging aids in selecting appropriate ECPR candidates by ruling out non-hypothermic cardiac arrest and major trauma.

## Abstract

Hypothermic cardiac arrest (HCA) with concomitant trauma presents a significant clinical management challenge. In these case reports, computed tomography (CT) imaging was performed before extracorporeal cardiopulmonary resuscitation (ECPR) in patients with cardiac arrest, accidental hypothermia, and trauma. The first case involved a 74-year-old male who collapsed outside his home under freezing conditions. Upon arrival at the emergency department (ED), he was in cardiac arrest with a core body temperature of 25.0°C and suspected head trauma. CT imaging revealed minor traumatic brain injuries and bilateral femoral fractures. ECPR was initiated after CT imaging, which led to successful rewarming and full neurological recovery. The second case describes a 32-year-old female who jumped from a bridge, experienced cardiac arrest during the rescue, and had a core temperature of 17.4°C. CT imaging before ECPR revealed no significant trauma. Despite prolonged resuscitation, the patient showed a complete neurological recovery. CT imaging before ECPR allows appropriate patient selection by ruling out cardiac arrest before hypothermia and major hemorrhagic complications. Hypothermic cardiac arrest may be acceptable for prolonged resuscitation time on CT imaging owing to reduced cerebral metabolism. These rare case reports demonstrate the potential benefits of CT imaging before ECPR in the management of hypothermic cardiac arrest with trauma and aid in appropriate candidate selection and effective intervention without compromising neurological outcomes.