Why the study?
Does an immediate angiography strategy reduce the 30-day risk of death from any cause compared to a delayed or selective strategy in patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation?
Does an immediate angiography strategy reduce the 30-day risk of death from any cause compared to a delayed or selective strategy in patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation?
Immediate angiography does not improve 30-day survival compared to a delayed or selective strategy in patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“TOMAHAWK was the second and largest randomised trial addressing the question of early coronary angiography in OHCA patients without ST-segment elevation. Like the COACT trial we found that early angiography was not superior to a delayed/selective approach. COACT was restricted to patients with shockable rhythm and TOMAHAWK extends the findings to patients with non-shockable rhythm.”
“Every single one of them did not show a clear benefit in terms of improvement in outcome. What we really want people to do is think before they take somebody to the lab, and to individualize care.”
“This statement recognizes that decision-making is not dichotomous and is much more nuanced when one is addressing the competing risks of acute ischemic cardiac injury and acute irreversible anoxic brain damage. It lays out several gray areas and allows clinicians by the bedside to use a broad number of variables to individualize whether a procedure is appropriate for the patient in front of them.”
Immediate angiography may be safely deferred in resuscitated OHCA without ST-elevation; reinforces low-certainty evidence against routine use.
Among patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, a strategy of performing immediate angiography provided no benefit over a delayed or selective strategy with respect to the 30-day risk of death from any cause. (Funded by the German Center for Cardiovascular Research; TOMAHAWK ClinicalTrials.gov number, NCT02750462.).
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Desch et al. (2021) studied this question.
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