Desch S, et al. - Researchers present the design and rationale of the TOMAHAWK trial, which is expected to resolve the issue of timing and general indication of angiography after out-of-hospital cardiac arrest (OHCA) without ST-segment elevation. Participants will be 558 patients with return of spontaneous circulation after OHCA with no obvious extra-cardiac origin of cardiac arrest and no ST-segment elevation/left bundle branch block on post-resuscitation ECG. These subjects will be assigned in 1:1 ratio to either immediate coronary angiography or initial intensive care assessment with delayed/selective angiography. The focus will be laid on 30-day all-cause mortality (the primary endpoint). Assessing initial rhythm, ECG patterns, myocardial infarction as underlying cause, neurological outcome, as well as clinical and laboratory markers, secondary analyses will be carried out. Bleeding and stroke will be assessed as safety endpoints. Participants will undergo clinical assessments at 6 and 12 months.