Title: Elevated ICP in the Post-ROSC Patient

Posted: 10/21/2025 by Mike Winters, MBA, MD

Check for Elevated ICP in the Post-ROSC Patient

More than 600,000 people experience out-of-hospital cardiac arrest (OHCA) in North America each year.
Unfortunately, only 10% of patients with OHCA survive to hospital discharge.
A key component of the ED management of the post-cardiac arrest patient centers on minimizing secondary cerebral injury.
In addition to monitoring for seizure activity in the comatose post-arrest patient, it is also recommended to assess the post-ROSC patient for elevated intracranial pressure (ICP).
This can be accomplished with neuroimaging (CT head) to look for cerebral edema, physical exam (pupillary asymmetry) and with POCUS measurements of the optic nerve sheath diameter.
In post-ROSC patients with signs of elevated ICP, raise the head of the bed, provide adequate sedation/analgesia, consider hypertonic saline, and optimize the mean arterial blood pressure.

Long B, Gottlieb M. Emergency medicine updates: Managing the patient with return of spontaneous circulation. Am J Emerg Med. 2025; 26-36.