Imaging in Circulatory Arrest: Lessons to be Learned

OBJECTIVE: This study describes the computed tomography (CT) features in patients with cardiac or circulatory arrest. METHODS: We retrospectively reviewed the CT of 5 patients (age range – 6–50 years) who had circulatory arrest while undergoing imaging, within a 12 month period in our Trauma and Emergency Centre. The presence or absence of contrast in the right and left chambers of heart, venous and arterial system, contrast density, and layering were assessed. RESULTS: Contrast pooling and layering in superior vena cava, inferior vena cava, and right heart chambers were common (5/5 patients). Left heart chambers and systemic arteries were non-opacified. Reflux of contrast was seen in hepatic veins (4/5), portal vein, and renal veins (2/5 patients). Three patients showed pooling in lumbar and posterior external venous plexus. One patient showed contrast in splenic and superior mesenteric vein and two patients had dense opacification of pelvic veins. All patients had a dismal prognosis and died within 24 h. CONCLUSION: The absence of left-sided chamber opacification and layering and pooling of dense contrast in the venous system is specific imaging signs of circulatory arrest. These features need to be recognized immediately, scanning terminated, and resuscitation initiated.