TOMAHAWK: Difference between revisions

Jump to navigation Jump to search

TOMAHAWK (view source)

Revision as of 02:04, 29 July 2022

331 bytes removed ,  29 July 2022
no edit summary
No edit summary
No edit summary
Line 33: Line 33:


==Bottom Line==
==Bottom Line==
There is no survival benefit for performing immediate PCI for resuscitated out of hospital arrest who have no post-resuscitation ST elevations
There is no survival benefit for performing immediate PCI for resuscitated out of hospital cardiac arrest (OHCA) who have no post-resuscitation ST elevations


==Major Points==  
==Major Points==  
Early revascularization has demonstrated benefits in preserving ventricular function in those with an acute myocardial infarction; however this intervention is not risk-free. A RCT in patients with NSTEMI and a shockable rhythm showed no difference in 90-day survival with early vs delated angiography
The role of angiography among those with out of hospital cardiac arrest (OHCA) was unclear. The TOMAHAWK trial randomized 554 adults with OHCA, regardless of shockable rhythm who didn't have primary indication for angiography (e.g., STEMI/LBBB) or clear non-cardiac reason for OHCA to immediate or delayed angiography. There was a higher rate of 30 day mortality among those brought for immediate angiography (54% vs. 46%; HR 1.28; 95% CI 1.00-1.63).


Reference: Dumas F, Bougouin W, Geri G, et al. Emergency percutaneous coronary intervention in post-cardiac arrest patients without ST-segment elevation pattern: insights from the PROCAT II Registry. JACC Cardiovasc Interv 2016;9:1011-8.
In general, TOMAHAWK supports a delayed angiography approach for OHCA with no clear ACS.  
 
More than half of out of hospital cardiac arrests are attributable to acute coronary syndrome and ST elevations post-resuscitation suggest an correctable coronary lesion with demonstrated benefit of immediate PCI. Lack of ST elevations post-resuscitation may be secondary to non-cardiac causes, but the value of immediate angiography is unknown.


==Guidelines==
==Guidelines==
Line 101: Line 99:


; Myocardial infarction
; Myocardial infarction
: 0% vs. 0.8% (RR 0; 95% CI 0-1.93)
: 0% vs. <1% (RR 0; 95% CI 0-1.93)


; Severe neurological deficit
; Severe neurological deficit
Tbplante
Bureaucrats, editor, reviewer, Administrators
6,381

edits

Retrieved from "http://www.wikijournalclub.org/wiki/Special:MobileDiff/39872"

Navigation menu