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September 2021

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Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation: New England Journal of Medicine, DZHK authors: Steffen Desch et al. for the TOMAHAWK Investigators

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Immediate coronary angiographies are not necessary, and can even cause worse outcomes, after a cardiac arrest where there is no obvious cause. These are the results presented from the TOMAHAWK-DZHK4 study at the European Congress of Cardiology, published simultaneously in the New England Journal of Medicine. The TOMAHAWK-DZHK4 study investigated whether people who had a cardiac arrest with an unclear cause had different survival rates depending on whether they had an early or delayed angiogram – or even none at all.

The researchers analysed the data from 530 patients who had been randomly divided into two groups. Of the 265 patients who received an immediate angiogram (around three hours after they arrived at the hospital), 143 of them had died 30 days later. The second group received intensive medical care for an average of two days after their cardiac arrest, before they had their angiogram.

If another cause of their cardiac arrest was identified in the meantime, an angiogram wasn’t carried out at all. In this group, 122 people died within the first 30 days and severe neurological damage was slightly less common, when compared to those who had an immediate angiogram.

What does this mean for the emergency department? TOMAHAWK principal investigator Steffen Desch recommends: "In the majority of patients, there is no reason to perform hasty coronary angiographies, especially in stressful situations like night services. Take time and follow the clinical course. If after one to two days no other causes for the cardiac arrest have been found, an angiogram can then bring clarity, but it’s not needed for every cardiac arrest with an unknown cause."

Link to paper

Link to Press Release