Patient handout

Post-cardiac-arrest care — initial non-shockable rhythm (PEA/asystole)

PRODUCTION

1. Your condition

This handout is for post-cardiac-arrest care — initial non-shockable rhythm (pea/asystole). Your care team identified this based on: rosc after pea or asystole arrest — lower neuro recovery + etiology often non-cardiac (aha 2020).

Other reasons your team may use this plan: non-shockable rhythm + post-rosc echo or troponin suggesting cardiac cause (massive mi, cardiogenic shock); reverse hs and ts screen required for non-shockable rhythm (aha 2020 class i).

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 µg/kg/min IV → titrate MAP ≥65	IV	continuous	AHA 2020 Class IIa; SOAP-II PMID 20200382 — preferred over dopamine in shock
dobutamine	2.5 µg/kg/min	IV	continuous; titrate to perfusion + UOP	AHA 2020; defer if isolated hypotension without low CI
propofol	5-50 µg/kg/min	IV	continuous; titrate RASS	PADIS 2018 PMID 30113379 — preferred sedative for TTM
fentanyl	25-100 µg IV bolus → 25-200 µg/h infusion	IV	continuous	PADIS 2018
magnesium sulfate	2 g IV q6h scheduled during cooling	IV	q6h	Sandroni 2021 — anti-shivering + arrhythmia prevention
calcium gluconate	1-2 g IV	IV	PRN for hyperK ECG changes	AHA 2020 Class I — membrane stabilization for hyperK as reversible PEA cause
insulin regular	10 U IV with 50 g D50W	IV	one-time + repeat PRN	AHA 2020 — intracellular K shift; 30-60 min duration
acetaminophen	650-1000 mg PO/IV q6h × 72h post-rewarm	PO/IV	q6h × 72h	AHA 2020 + Sandroni 2021 — fever prevention × 72h post-rewarm

Plan: Non-shockable OHCA phenotype — reversible-cause therapy + HYPERION TTM 33 °C + GOC trajectory (AHA 2020 + HYPERION + Sandroni 2021)

3. When to call your provider

Contact your care team if any of the following happen:

New cognitive decline → mental health + neuropsych
Worsening HF → advanced HF eval
Caregiver burnout → palliative + social work

4. When to seek emergency care

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

GCS motor ≤2 off sedation + status myoclonus + bilateral absent N20 SSEP + diffuse anoxic injury on MRI at ≥72h post-rewarm — multimodal poor neuro prognosis (Sandroni 2021)
Structured GOC family meeting at 72h post-rewarm (per AHA 2020 + Sandroni 2021) given baseline poor prognosis in non-shockable cohort
WLST decision made + patient meets brain death or DCD criteria → organ-donation evaluation by OPO
K >6.5 + ECG changes (peaked T, wide QRS) — reversible cause of PEA/asystole (AHA 2020 Class I)(life-threatening)
Post-ROSC SBP <90 + lactate ≥2 — massive MI causing PEA arrest + ongoing cardiogenic shock (SCAI 2022 stage C+)(life-threatening)

5. Follow-up

For survivors with meaningful recovery: cardiology + EP follow-up if structural disease; heart pumping strength (LVEF) reassessment for ICD eligibility; cardiac rehab; mental health; significant cognitive impairment common post non-shockable arrest (AHA 2020 Class I)

6. Sources

Guideline: 2020 AHA ACLS / Post-Cardiac-Arrest Care + 2021 ERC-ESICM Post-Resuscitation Guideline