Post-cardiac arrest imaging: Unraveling etiology and predicting neurological outcome

Abstract

Cardiac arrest is associated with high rates of mortality and significant long-term neurological disability in survivors. Timely and accurate assessment following successful resuscitation is critical for optimizing outcomes. Imaging plays a central role in this evaluation process, providing crucial insights into the etiology of arrest, the extent of cerebral and cardiac injury, and guiding both acute management and long-term prognostication. A structured, multimodal imaging approach utilizing tools such as computed tomography, magnetic resonance imaging, echocardiography, and angiography is increasingly recognized as essential in the post-cardiac arrest setting. This review aims to consolidate current evidence related to the use of various imaging modalities across neurological, cardiac and systemic contexts. Particular emphasis is placed on the prognostic value and optimal timing of neuroimaging, the detection of potentially reversible causes of arrest, such as coronary occlusion or pulmonary embolism, and the emerging role of whole-body imaging in evaluating patients with non-traumatic out-of-hospital cardiac arrest.

Keywords: Post cardiac arrest setting; Return of spontaneous circulation; Imaging; Computed tomography; Magnetic resonance imaging; Coronary angiography; Echocardiography

Core Tip: Imaging is vital after cardiac arrest, aiding diagnosis, management, and prognosis. A structured, multimodal approach-including brain, cardiac, chest and abdominopelvic imaging, echocardiography, and angiography-identifies reversible causes, guides therapy, and assesses injury. Whole-body imaging enhances diagnostic yield, enabling rapid, comprehensive evaluation and supporting improved outcomes in survivors.