TOMAHAWK

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation

Desch S et al. NEJM 2021. DOI: 10.1056/NEJMoa2101909

Clinical Question
-  In adults > 30 years old suffering out-of-hospital cardiac arrest (OOHCA) without ST elevation on their ECG does routine immediate coronary angiography compared to a delayed or selective approach to coronary angiography improve 30-day all-cause mortality?

N = 554, 31 sites in Germany and Denmark

Authors’ Conclusions
-  In resuscitated patients with a possible cardiac cause of OOHCA without ST elevation or LBBB an immediate coronary angiography strategy did not reduce 30 day risk of death from any cause compared to a delayed or selective coronary angiography strategy

The Bottom Line
-  For patients presenting with a suspected cardiac cause of OOHCA who are haemodynamically stable, there appears to be no benefit from immediate angiography
-  As such, admission to the ICU for ongoing stabilisation and investigation is a reasonable initial management strategy for this group of patients
-  For patients with haemodynamic compromise or electrical instability I will continue to discuss with cardiology about optimal timing for angiography

Further trials such as ARREST and DISCO will continue to inform practice