The writing committee endorses the need for further research into the implementation of prehospital strategies to reduce total ischemic time. 3.6. The Relationship Between Sudden Cardiac Death and STEMI 3.6.1. Evaluation and Management of Patients With STEMI and Out-of-Hospital Cardiac Arrest: Recommendations Class I 1. Therapeutic hypothermia should be started as soon as possible in comatose patients with STEMI and out-of-hospital cardiac arrest caused by ventricular fibrillation (VF) or pulseless ventricular tachycar- dia (VT), including patients who undergo primary (Level of Evidence: B) 2. Immediate angiography and PCI when indicated should be performed in resuscitated out-of-hospital cardiac arrest patients whose initial ECG shows (Level of Evidence: B) See Online Data Supplement 2 for additional data on PCI for cardiac arrest. 