Patient handout

Post-cardiac-arrest care — TTM protocol (cooling, rewarm, fever prevention)

PRODUCTION

1. Your condition

This handout is for post-cardiac-arrest care — ttm protocol (cooling, rewarm, fever prevention). Your care team identified this based on: comatose rosc patient (gcs motor ≤5) — ttm candidate per ttm2 / hyperion (aha 2020 class i).

Other reasons your team may use this plan: core temperature >37.5 °c post-rosc requiring active fever prevention (ttm2 pmid 34133859); rosc with team decision to initiate ttm device (surface or intravascular) within 4h (sandroni 2021).

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
propofol	5-50 µg/kg/min IV	IV	continuous; titrate to RASS -4 to -5 during cooling	PADIS 2018 PMID 30113379 — preferred sedative for TTM; rapid offset enables daily neuro exam during rewarm + fever-prevention phase
fentanyl	25-100 µg IV bolus → 25-200 µg/h infusion	IV	continuous	PADIS 2018; complements propofol; cooling reduces fentanyl clearance — anticipate dose reduction during maintenance phase
magnesium sulfate	2 g IV q6h scheduled during cooling phase	IV	q6h scheduled	BSAS-driven anti-shivering + arrhythmia prevention (cooling drops Mg); Sandroni 2021
buspirone	30 mg PO/NG q8h scheduled during cooling	PO/NG	q8h	Anti-shivering adjunct to reduce sedative requirement (Choi NCC 2011)
cisatracurium	0.15 mg/kg load → 1-3 µg/kg/min infusion	IV	continuous	Used only with adequate sedation; minimize duration to enable neuro exam during rewarm (Sandroni 2021)
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
acetaminophen	650-1000 mg PO/IV q6h scheduled during 72h post-rewarm fever prevention	PO/IV	q6h × 72h post-rewarm	TTM2 PMID 34133859 — fever prevention × 72h is the key intervention; Sandroni 2021

Plan: TTM protocol phenotype — target choice + sedation + shivering control + fever prevention (TTM2 + HYPERION + Sandroni 2021)

3. When to call your provider

Contact your care team if any of the following happen:

ICD therapy delivered → urgent EP
EF declining despite the four foundational heart-failure medications → advanced HF eval
New cognitive decline / 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:

BSAS ≥2 despite propofol 50 µg/kg/min + fentanyl 200 µg/h + Mg 2g q6h + buspirone 30 mg q8h
Core temp ≥38 °C during 72h post-rewarm fever-prevention phase
INR >1.5 or PTT >50 + active bleeding during 33 °C cooling phase

5. Follow-up

Post-TTM cognitive screen at d/c + 3 mo; neuropsychology referral if anoxic injury; cardiac rehab; hand-off to long-term cardiology + EP if structural disease (AHA 2020)

6. Sources

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