Patient handout

Post-cardiac-arrest care (cardiology-driven, ischemic-OHCA pathway)

PRODUCTION

1. Your condition

This handout is for post-cardiac-arrest care (cardiology-driven, ischemic-ohca pathway). Your care team identified this based on: rosc after vf/pvt cardiac arrest (aha 2020 §3; arrest 2020).

Other reasons your team may use this plan: stemi on first post-rosc ecg (aha 2020 class i; esc 2023 acs); comatose rosc with suspected cardiac etiology — ttm candidate (ttm2 dankiewicz nejm 2021); known cad / prior mi / cardiomyopathy + rosc (aha 2020).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162–325 mg chewed (or PR if intubated)	PO/PR	load + 81 mg daily	ACC/AHA 2025 ACS Class I; ISIS-2 (PMID 2899772)
ticagrelor	180 mg load → 90 mg BID	PO/NG	BID	PLATO (Wallentin NEJM 2009 PMID 19717846); preferred over clopidogrel in invasive strategy
unfractionated heparin	70–100 U/kg IV bolus → infusion to ACT 250–300	IV	bolus + continuous	AHA 2025 ACS Class I; HORIZONS-AMI (PMID 18499566)
atorvastatin	80 mg	PO/NG	daily	PROVE-IT TIMI-22 (PMID 15007110); IMPROVE-IT (PMID 26039521)
metoprolol succinate	25 mg PO daily — defer if shock or AV block	PO/NG	daily; titrate	CAPRICORN (PMID 11356434); REDUCE-AMI 2024 nuance for preserved-EF (PMID 38959490)

Plan: Post-arrest cardiac-etiology phenotype ladder — drives TTM + reperfusion + MCS coordination (AHA 2020 + TTM2 + DanGer Shock + ARREST)

3. When to call your provider

Contact your care team if any of the following happen:

ICD therapy delivered → urgent EP eval; consider antiarrhythmic + ablation per VANISH (PMID 27149033)
EF declining on serial echo despite the four foundational heart-failure medications → advanced HF eval
New angina / abnormal stress → cath
New depression / PTSD symptom → mental health referral

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Recurrent VF/pVT episodes post-ROSC despite ACLS pharmacotherapy (AHA 2020 ACLS)(life-threatening)
ST elevation meeting STEMI criteria on first post-ROSC ECG (AHA 2020 Class I — emergent cath)(life-threatening)
Persistent VF/pVT despite ≥3 defib + amiodarone + epinephrine; meets ARREST criteria (age 18-75, witnessed, bystander CPR, low-flow <60 min)(life-threatening)
Post-ROSC SBP <90 + lactate ≥2 + cool extremities + AKI — SCAI 2022 stage C+(life-threatening)
At ≥72h post-rewarm, ≥2 of: bilateral absent N20 SSEP + status myoclonus on EEG + NSE >60 ng/mL + diffuse anoxic injury on MRI + GCS motor ≤2 off sedation

5. Follow-up

Cardiology + electrophysiology follow-up at 1-2 weeks; heart pumping strength (LVEF) reassessment at 40-90 days for primary-prevention ICD eligibility (MADIT-II); WCD bridge if EF <35% during waiting period (VEST trial PMID 30280654); cardiac rehab (AHA 2020 Class I); sudden-cardiac-death prevention bundle

6. Sources

Guideline: 2020 AHA ACLS / Post-Cardiac-Arrest Care + 2021 ERC-ESICM Post-Resuscitation + 2025 ACC/AHA ACS + 2022 ACC/AHA HF (with 2023 Focused Update)