Out-of-hospital Cardiac Arrest Clinical Trial
Official title:
Immediate Unselected Coronary Angiography Versus Delayed Triage in Survivors of Out-of-hospital Cardiac Arrest Without ST-segment Elevation
The aim of the trial is to compare immediate angiography in survivors of out of hospital
cardiac arrest (OHCA) without ST-segment elevation versus delayed/selective catheterization
with respect to 30 day mortality.
The TOMAHAWK trial is supported by the Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK).
After inclusion and exclusion criteria have been checked patients will be randomized:
Group 1: Immediate angiography Patients randomized to group 1 will be transported to the
catheterization laboratory as soon as possible after hospital admission for evaluation of
coronary anatomy.
Group 2: Delayed/selective angiography Upon hospital admission, patients assigned to group 2
will first be transported to the ICU for further evaluation and stratification of OHCA
etiology. Further triage will depend on the results of clinical examination and objective
testing and will be left to the individual physician according to clinical judgment.
Depending on clinical circumstances, further management may comprise medical therapy,
laboratory testing, imaging such as echocardiography and/or computed tomography, hemodynamic
or neurological monitoring, the initiation of therapeutic hypothermia or other measures of
intensive care. If a high likelihood of an acute coronary trigger for OHCA persists (i.e.
inconclusive results from clinical evaluation with ongoing suspicion of an acute coronary
event, etc.), the treating physician may proceed to coronary angiography after a delay of 24h
after the onset of cardiac arrest.
Vital status will be assessed at 30 days, 6 and 12 months after randomization by direct
questioning if the patient is still hospitalized or structured telephone interview. Clinical
events will be verified by original source data. At 6 and 12 months, quality of life will be
assessed by the the Euroqol 5D questionnaire.
The TOMAHAWK trial is supported by the Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK).
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