• American heart journal · Mar 2019

    Randomized Controlled Trial Multicenter Study

    Immediate unselected coronary angiography versus delayed triage in survivors of out-of-hospital cardiac arrest without ST-segment elevation: Design and rationale of the TOMAHAWK trial.

    • Steffen Desch, Anne Freund, Tobias Graf, Stephan Fichtlscherer, Hendrik Haake, Michael Preusch, Fabian Hammer, Ibrahim Akin, Martin Christ, Christoph Liebetrau, Carsten Skurk, Stephan Steiner, Ingo Voigt, Roland Schmitz, Harald Mudra, Jakob Ledwoch, Niels Menck, Jan Horstkotte, Klaus Pels, Anna-Lena Lahmann, Sylvia Otto, Karsten Lenk, Marc-Alexander Ohlow, Christian Hassager, Peter Nordbeck, Uwe Zeymer, Alexander Jobs, Suzanne de Waha-Thiele, Denise Olbrich, Inke König, Kathrin Klinge, and Holger Thiele.
    • Universitäres Herzzentrum Lübeck, Lübeck, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany; Herzzentrum Leipzig-Universitätsklinik für Kardiologie, Leipzig, Germany. Electronic address: steffen.desch@medizin.uni-leipzig.de.
    • Am. Heart J. 2019 Mar 1; 209: 20-28.

    Patients experiencing out-of-hospital cardiac arrest (OHCA) without ST-segment elevation are a heterogenic group with a variety of underlying causes. Up to one-third of patients display a significant coronary lesion compatible with myocardial infarction as OHCA trigger. There are no randomized data on patient selection and timing of invasive coronary angiography after admission. METHODS AND ResultsThe TOMAHAWK trial randomly assigns 558 patients with return of spontaneous circulation after OHCA with no obvious extracardiac origin of cardiac arrest and no ST-segment elevation/left bundle-branch block on postresuscitation electrocardiogram to either immediate coronary angiography or initial intensive care assessment with delayed/selective angiography in a 1:1 ratio. The primary end point is 30-day all-cause mortality. Secondary analyses will be performed with respect to initial rhythm, electrocardiographic patterns, myocardial infarction as underlying cause, neurological outcome, as well as clinical and laboratory markers. Clinical follow-up will be performed at 6 and 12 months. Safety end points include bleeding and stroke. ConclusionThe TOMAHAWK trial will address the unresolved issue of timing and general indication of angiography after OHCA without ST-segment elevation.Copyright © 2018 Elsevier Inc. All rights reserved.

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