TOMAHAWK is a prospective, randomized, multi-center, controlled trial. A total of 558 patients will be randomized. The primary objective is to compare immediate coronary angiography with deferred or selective coronary angiography in survivors of out-of-hospital cardiac arrest (OHCA) without ST-segment elevation with regards to 30-day mortality. 

Inclusion criteria

  • Documented resuscitated out-of-hospital cardiac arrest 
of possible cardiac origin and return of spontaneous circulation 

  • Age ≥30 years
  • Informed consent

Exclusion criteria

  • ST-segment elevation or left bundle branch block
  • No return of spontaneous circulation upon hospital admission 

  • Severe hemodynamic or electrical instability requiring immediate angiography/intervention (delay clinically not acceptable) 

  • Obvious extracardiac 
etiology such as traumatic brain injury, primary metabolic or electrolyte disorders, intoxication, overt hemorrhage, respiratory failure due to known lung disease, suffocation, drowning
  • In-hospital cardiac arrest
  • Known or likely pregnancy 

  • Participation in another intervention study



The study flow is as follows:


Patient enrollment started in November 2016.

The results of the TOMAHAWK trial will improve the treatment algorithm of patients with OHCA without ST-segment elevation. Using data from a prospective randomized trial physicians will be able to clearly decide on the approach which may increase the survival of those patients based on scientific evidence.