Out of hospital cardiac arrest (OHCA) remains a challenging cause of cardiac and neurological mortality and morbidity. Complicating recent management has been the complex clinical and etiological factors surrounding the COVID – 19 Pandemic causing often later presentations for symptomatic cardiac events resulting in more frequent cardiac arrest. Ischemia associated with acute myocardial infarction (AMI) is a well-known causal substrate from the time of AMI onset persisting up to six months post infarction. However, it is also known that multiple other causes are involved including cardiomyopathies (both ischemic and non-ischemic with low left ventricular ejection fractions). Thus, while ischemic etiologies can be identified in the majority of cases, acute reversible ischemia is not the primary cause of cardiac arrest in patients .