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; Holger Thiele

doi:10.1016/j.ahj.2018.12.005

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 LahmannSylvia Otto, Karsten Lenk, Marc-Alexander Ohlow, Christian Hassager, Peter Nordbeck, Uwe Zeymer, Alexander Jobs, Suzanne de Waha-Thiele, Denise Olbrich, Inke König, Kathrin Klinge, Holger Thiele

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

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 RESULTS: The 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. CONCLUSION: The TOMAHAWK trial will address the unresolved issue of timing and general indication of angiography after OHCA without ST-segment elevation.

Original language	English
Journal	American Heart Journal
Volume	209
Pages (from-to)	20-28
Number of pages	9
ISSN	0002-8703
DOIs	https://doi.org/10.1016/j.ahj.2018.12.005
Publication status	Published - Mar 2019

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10.1016/j.ahj.2018.12.005

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Desch, S., Freund, A., Graf, T., Fichtlscherer, S., Haake, H., Preusch, M., Hammer, F., Akin, I., Christ, M., Liebetrau, C., Skurk, C., Steiner, S., Voigt, I., Schmitz, R., Mudra, H., Ledwoch, J., Menck, N., Horstkotte, J., Pels, K., ... Thiele, H. (2019). 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. American Heart Journal, 209, 20-28. https://doi.org/10.1016/j.ahj.2018.12.005

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. / Desch, Steffen; Freund, Anne; Graf, Tobias et al.

In: American Heart Journal, Vol. 209, 03.2019, p. 20-28.

Research output: Contribution to journal › Journal article › Research › peer-review

Desch, S, Freund, A, Graf, T, Fichtlscherer, S, Haake, H, Preusch, M, Hammer, F, Akin, I, Christ, M, Liebetrau, C, Skurk, C, Steiner, S, Voigt, I, Schmitz, R, Mudra, H, Ledwoch, J, Menck, N, Horstkotte, J, Pels, K, Lahmann, A-L, Otto, S, Lenk, K, Ohlow, M-A, Hassager, C, Nordbeck, P, Zeymer, U, Jobs, A, de Waha-Thiele, S, Olbrich, D, König, I, Klinge, K & Thiele, H 2019, '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', American Heart Journal, vol. 209, pp. 20-28. https://doi.org/10.1016/j.ahj.2018.12.005

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title = "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",

abstract = "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 RESULTS: The 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. CONCLUSION: The TOMAHAWK trial will address the unresolved issue of timing and general indication of angiography after OHCA without ST-segment elevation.",

author = "Steffen Desch and Anne Freund and Tobias Graf and Stephan Fichtlscherer and Hendrik Haake and Michael Preusch and Fabian Hammer and Ibrahim Akin and Martin Christ and Christoph Liebetrau and Carsten Skurk and Stephan Steiner and Ingo Voigt and Roland Schmitz and Harald Mudra and Jakob Ledwoch and Niels Menck and Jan Horstkotte and Klaus Pels and Anna-Lena Lahmann and Sylvia Otto and Karsten Lenk and Marc-Alexander Ohlow and Christian Hassager and Peter Nordbeck and Uwe Zeymer and Alexander Jobs and {de Waha-Thiele}, Suzanne and Denise Olbrich and Inke K{\"o}nig and Kathrin Klinge and Holger Thiele",

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T1 - Immediate unselected coronary angiography versus delayed triage in survivors of out-of-hospital cardiac arrest without ST-segment elevation

T2 - Design and rationale of the TOMAHAWK trial

AU - Desch, Steffen

AU - Freund, Anne

AU - Graf, Tobias

AU - Fichtlscherer, Stephan

AU - Haake, Hendrik

AU - Preusch, Michael

AU - Hammer, Fabian

AU - Akin, Ibrahim

AU - Christ, Martin

AU - Liebetrau, Christoph

AU - Skurk, Carsten

AU - Steiner, Stephan

AU - Voigt, Ingo

AU - Schmitz, Roland

AU - Mudra, Harald

AU - Ledwoch, Jakob

AU - Menck, Niels

AU - Horstkotte, Jan

AU - Pels, Klaus

AU - Lahmann, Anna-Lena

AU - Otto, Sylvia

AU - Lenk, Karsten

AU - Ohlow, Marc-Alexander

AU - Hassager, Christian

AU - Nordbeck, Peter

AU - Zeymer, Uwe

AU - Jobs, Alexander

AU - de Waha-Thiele, Suzanne

AU - Olbrich, Denise

AU - König, Inke

AU - Klinge, Kathrin

AU - Thiele, Holger

PY - 2019/3

Y1 - 2019/3

N2 - 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 RESULTS: The 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. CONCLUSION: The TOMAHAWK trial will address the unresolved issue of timing and general indication of angiography after OHCA without ST-segment elevation.

AB - 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 RESULTS: The 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. CONCLUSION: The TOMAHAWK trial will address the unresolved issue of timing and general indication of angiography after OHCA without ST-segment elevation.

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DO - 10.1016/j.ahj.2018.12.005

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JO - American Heart Journal

JF - American Heart Journal

ER -

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

Abstract

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