The COACT trial demonstrated no improvement in 90-day mortality for post-arrest patients without evidence of an ST-segment elevation MI who were randomized to immediate or delayed coronary angiography.  However, the COACT Trial included only OHCA with a shockable rhythm and overall had a very low number of patients that had an acute thrombus at the time of angiography.  In this podcast, we discuss the recently published TOMAHAWK study that evaluated OHCA patients due to either a shockable or nonshockable rhythm and had no evidence of a STEMI.  Should this study change our post-arrest management of OHCA patients with a non-diagnostic ECG?