Patient handout

Post-cardiac-arrest care — drowning-induced cardiac arrest

PRODUCTION

1. Your condition

This handout is for post-cardiac-arrest care — drowning-induced cardiac arrest. Your care team identified this based on: rosc after submersion / drowning-induced cardiac arrest (aha 2020 §drowning).

Other reasons your team may use this plan: comatose patient post-drowning with core temp <32 °c — extended acls warranted; ttm candidate (schneider 2014 pmid 25034567); witnessed drowning + low-flow <90 min + core temp 28-32 °c with vf/asystole — ecmo/ecpr consideration (elso drowning protocol).

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
norepinephrine	0.05-0.5 µg/kg/min titrate MAP ≥65	IV	continuous	SOAP-II PMID 20200382; first-line post-ROSC vasoactive
amiodarone	300 mg IV bolus → 150 mg if recurrent → 1 mg/min × 6h → 0.5 mg/min × 18h; HOLD additional doses if core <30 °C	IV	modified for hypothermia	AHA 2020 ACLS Class IIb; in hypothermia limit to 1 dose until warmed >30 °C, then resume standard cadence
epinephrine	1 mg IV q3-5 min if normothermic; if core <30 °C → withhold further doses; if 30-34 °C → space q6-10 min	IV	modified for hypothermia	AHA 2020 ACLS — modified dosing intervals for hypothermia
magnesium sulfate	1-2 g IV	IV	one-time + repeat for TdP	AHA 2020 ACLS Class IIa for TdP; correct hypomagnesemia first
propofol	5-50 µg/kg/min	IV	continuous; titrate RASS	PADIS 2018; hepatic metabolism slowed in hypothermia → reduce dose during cooling
fentanyl	25-200 µg/h	IV	continuous	PADIS 2018; analgesia + shivering suppression for TTM
tranexamic acid	1 g IV over 10 min	IV	within 3h of bleeding onset	CRASH-2 PMID 20554319 if traumatic bleeding co-existing with drowning
ceftriaxone	2 g IV daily	IV	daily	Early empiric for aspiration pneumonia from drowning — typically broad gram-negative + anaerobe coverage; consider piperacillin-tazobactam if water-source contamination concern

Plan: Drowning-induced post-arrest phenotype — modified ACLS for hypothermia + active warming + ARDS management + ECPR bridge consideration (AHA 2020 + Schneider 2014 + ELSO drowning)

3. When to call your provider

Contact your care team if any of the following happen:

ICD therapy delivered → urgent EP; consider catheter ablation per VANISH (PMID 27149033) if structural substrate
EF declining despite the four foundational heart-failure medications → advanced HF eval
Substance-use relapse with safety risk → urgent intervention

4. When to seek emergency care

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

Core temperature <30 °C in drowning-induced arrest — withhold further ACLS drug doses + limit defib to 1 attempt until warmed; warm to 32-35 °C before declaring death (AHA 2020 hypothermia section)(life-threatening)
Witnessed drowning + low-flow time <90 min + core temp 28-32 °C with VF/asystole at presentation + ROSC achievable post-warming — ECMO bridge candidate per ELSO drowning + Schneider 2014(life-threatening)
Severe ARDS post-drowning (P/F <150 with bilateral infiltrates) — proning per PROSEVA + neuromuscular blockade per ACURASYS (controversial); VV-ECMO if refractory
Serum K >10 mmol/L on arrival from drowning arrest — historically poor prognosis marker per ELSO drowning consensus, but cold-water + witnessed cases warrant continued resuscitation(life-threatening)
Diving / unwitnessed / suspected trauma → C-spine immobilization + CT C-spine + trauma surgery activation + MILS during airway management

5. Follow-up

Pulmonology follow-up for ARDS sequelae; cardiology + EP follow-up if cardiac trigger (LQTS, Brugada, structural); rehab for cognitive sequelae; mental health (post-arrest PTSD, family); substance-use referral if alcohol/drug precipitated; aquatic safety education

6. Sources

Guideline: AHA 2020 ACLS / Post-Cardiac-Arrest Care drowning + hypothermia sections + ELSO drowning consensus + ARDSnet + PROSEVA + Schneider 2014 cold-water drowning