6/30/23, 2:17 AM TOMAHAWK Pathway Feedback Search Clinical Topics Home Studies TOMAHAWK TOMAHAWK Disease Cardiac arrest Trial question Is immediate angiography superior to delayed angiography in patients with resuscitated out-of- hospital cardiac arrest without ST-segment elevation? Study design Multi-center Open label RCT Population Characteristics of study participants 30.0% female N = 530 70.0% male 530 patients (161 female, 369 male) Inclusion criteria: adults with successfully resuscitated out-of-hospital cardiac arrest of possible cardiac origin Key exclusion criteria: ST-segment elevation or new LBBB; no ROSC upon hospital admission; the need for immediate coronary angiography/intervention; obvious extra-cardiac etiology or in- hospital cardiac arrest Interventions N=265 immediate-angiography (immediate coronary angiography) N=265 delayed-angiography (initial intensive care assessment with delayed or selective angiography) https://web.pathway.md/studies/recwz8D7ysqvzMGdX 1/2 6/30/23, 2:17 AM TOMAHAWK Pathway Primary outcome Death from any cause at day 30 54.0 % 54 46 40.5 % 27.0 % 13.5 % Borderline significant increase 0.0 % Immediate-angiography Delayed-angiography Borderline significant increase in death from any cause at day 30 (54% vs. 46%; HR 1.28, 95% CI 1 to 1.63) Secondary outcomes Borderline significant increase in death or severe neurologic deficit at day 30 (64.3% vs. 55.6%; RR 1.16, 95% CI 1 to 1.34) No significant difference in severe neurologic deficit (18.8% vs. 12.7%; RR 1.48, 95% CI 0.82 to 2.67) Safety outcomes No significant differences in moderate or severe bleeding, stroke, acute kidney failure leading to renal-replacement therapy. Conclusion In adults with successfully resuscitated out-of-hospital cardiac arrest of possible cardiac origin, immediate-angiography was inferior to delayed-angiography with respect to death from any cause at day 30. Reference Steffen Desch, Anne Freund, Ibrahim Akin et al. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. N Engl J Med. 2021 Dec 30;385(27):2544-2553. Open reference URL https://web.pathway.md/studies/recwz8D7ysqvzMGdX 2/2