Patient handout

Post-cardiac-arrest care — initial shockable rhythm (VF/pVT)

PRODUCTION

1. Your condition

This handout is for post-cardiac-arrest care — initial shockable rhythm (vf/pvt). Your care team identified this based on: rosc after vf/pvt cardiac arrest — cardiac etiology >80% probability (aha 2020).

Other reasons your team may use this plan: stemi on first post-rosc ecg following shockable-rhythm arrest → emergent cath (aha 2020 class i); vf/vt-driven arrest unrelated to reversible cause → icd secondary-prevention indication (avid pmid 9411221).

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 × 12 mo	PLATO Wallentin NEJM 2009 PMID 19717846
unfractionated heparin	70-100 U/kg IV bolus → infusion to ACT 250-300	IV	bolus + continuous	AHA 2025 ACS Class I
atorvastatin	80 mg	PO/NG	daily	PROVE-IT TIMI-22 PMID 15007110
amiodarone	150 mg IV bolus → 1 mg/min × 6h → 0.5 mg/min × 18h	IV	continuous taper	AHA 2020 ACLS Class IIb; ALIVE PMID 11136442
lidocaine	1-1.5 mg/kg IV bolus → 1-4 mg/min infusion	IV	bolus + continuous	AHA 2020 ACLS
magnesium sulfate	1-2 g IV	IV	one-time + repeat for TdP	AHA 2020 ACLS Class IIa for TdP
metoprolol succinate	25 mg PO daily — defer if shock	PO/NG	daily; titrate	CAPRICORN PMID 11356436 post-MI BB

Plan: Shockable-rhythm OHCA phenotype — STEMI vs non-STEMI cath strategy + secondary-prevention ICD pathway (AHA 2020 + COACT + TOMAHAWK + AVID)

3. When to call your provider

Contact your care team if any of the following happen:

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

4. When to seek emergency care

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

ST elevation meeting STEMI criteria on first post-ROSC ECG following shockable-rhythm arrest — emergent cath (AHA 2020 Class I)(life-threatening)
Recurrent VF/pVT episodes post-ROSC despite ACLS pharmacotherapy (AHA 2020 ACLS)(life-threatening)
VF/VT-driven arrest unrelated to reversible cause + meaningful neurologic recovery → secondary-prevention ICD indication during admission (AVID PMID 9411221)
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 — SCAI 2022 stage C+(life-threatening)

5. Follow-up

EP follow-up at 1-2 weeks for ICD planning; heart pumping strength (LVEF) reassessment at 40-90 d if MADIT-II eligible; secondary-prevention ICD per AVID if VF/VT unrelated to reversible cause; cardiac rehab

6. Sources

Guideline: 2020 AHA ACLS / Post-Cardiac-Arrest Care + 2025 ACC/AHA ACS + 2017 HRS expert consensus on inherited arrhythmia syndromes