This handout is for stemi complicated by out-of-hospital cardiac arrest with rosc. Your care team identified this based on: stemi on first post-rosc 12-lead ecg → emergent cath within 90 min + ttm concurrent (aha 2020 class i).
Other reasons your team may use this plan: comatose rosc + stemi ecg → concurrent cath pci + ttm 33-37.5 °c × 24 h (ttm2); witnessed shockable arrest + rosc + stemi on subsequent ecg — composite engine activates.
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 PR or via NG tube (patient comatose post-ROSC) | PR/NG | load + 81 mg daily | AHA 2025 ACS Class I; PR/NG route given comatose state; same as parent STEMI |
| ticagrelor | 180 mg crushed via NG tube; 90 mg BID maintenance | NG → PO | BID × 12 mo DAPT | PLATO PMID 19717846; crushed administration via NG during TTM has reduced absorption — consider cangrelor IV bridge for high-risk anatomy or shock |
| unfractionated_heparin | 70-100 U/kg IV bolus + cath-lab maintenance per ACT | IV | bolus + infusion | AHA 2025 Class I; standard cath-lab AC |
| atorvastatin | 80 mg via NG tube | NG → PO | daily | PROVE-IT PMID 15007110; high-intensity statin |
| propofol | 25-75 mcg/kg/min infusion (intubated, sedated for TTM) | IV | continuous infusion | Sedation during TTM; rapid titration; consider midazolam alternative if hypotension |
| fentanyl | 25-100 mcg/h infusion | IV | continuous infusion | Analgesia during TTM; reduces shivering threshold |
| norepinephrine | 0.05-0.5 mcg/kg/min IV titrate to MAP ≥65 | IV | continuous infusion | SOAP-II PMID 20200382 — norepinephrine first-line; AHA 2020 Class IIa MAP ≥65 target |
| dobutamine | 2.5-10 mcg/kg/min IV titrate | IV | continuous infusion | Inotropic support post-PCI when low CO drives shock; AHA 2020 |
| amiodarone | 150 mg IV bolus → 1 mg/min × 6 h → 0.5 mg/min | IV | continuous infusion × 24 h | AHA 2020 ACLS Class IIb; recurrent VT/VF post-reperfusion common; AHA 2017 VA management |
| magnesium_sulfate | 2 g IV bolus; repeat × 1 if Mg <2 | IV | bolus | Goal Mg ≥2 to suppress arrhythmia; intracellular Mg often depleted post-arrest |
| cisatracurium | 0.15 mg/kg IV bolus then 0.5-2 mcg/kg/min infusion | IV | continuous infusion | NMB to break shivering during TTM only when sedation + counter-warming inadequate; mask seizures so EEG monitoring required |
Plan: STEMI + OHCA composite — concurrent reperfusion bundle + TTM sedation + MAP support + recurrent-VT prophylaxis
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Multimodal neuroprognostication ≥72 h post-rewarming per Sandroni ERC-ESICM 2021 (clinical exam + EEG + SSEP + NSE + neuroimaging); ICD secondary-prevention per AVID once acute reversible cause addressed (any sustained VT/VF arrest in setting of STEMI usually qualifies); cardiology + EP + neurology follow-up; cardiac rehab; mental health (PTSD/anoxic injury cognitive screening)
Guideline: 2025 ACC/AHA ACS Guideline + AHA 2020 ACLS / Post-Cardiac-Arrest Care + ERC-ESICM 2021 Post-Resuscitation