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