Unexpected return of spontaneous circulation after cessation of resuscitation (Lazarus phenomenon)1
Introduction
Recently, two reports on unexpected return of spontaneous circulation (ROSC) after cessation of cardiopulmonary resuscitation (CPR) were published in Resuscitation 1, 2. Neither of these gave references to similar cases. As we have experienced one case in our own practice, we report it here along with the results of a literature search.
Section snippets
Case report
The patient was an 80-year-old white male. He had been admitted to the anaesthesiology intensive care unit because of pancreatitis, infection with multi-resistant staphylococcus aureus (MRSA) and a cerebral infarction. At 04:00 the physician on duty was called because of seizures. Electrocardiography (ECG) showed bradyasystole with an unrecordable blood pressure (an arterial line was in situ). The patient was orotracheally intubated and ventilated with volume control and closed chest
Methods
We searched Medline on CD (Silverplatter, volumes 1966–June 1998 of the 1998 edition) for the following items:
- 1.
(resuscitat* OR reanimat* OR cpr) AND (discontin* OR suspend* OR terminat* OR cessat* OR halt*) AND (spontaneous* OR recover* OR restor* OR return* OR rosc)
- 2.
(resuscitat* OR reanimat* OR cpr) AND (hyperinflat* OR auto-peep)
- 3.
lazarus IN TI
Related secondary literature was included as well as the publications found in our personal literature data base.
Cases were considered eligible if patients
Results
Medline identified nine relevant original publications 2, 3, 4, 5, 6, 7, 8, 9, 10and three comments thereon 11, 12, 13. Five publications were included from our files 1, 14, 15, 16, 17. The details are given in Table 1.
Discussion
Since the first description by Linko et al. in 1982 [3], reports of more than 20 patients with ROSC after cessation of CPR have been published (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 14, 15, 16, 17, Table 1). At least eight of these were discharged able to care for themselves. This was termed the `Lazarus phenomenon' by Bray [8]refering to the biblical character Lazarus, who was resurrected from death by Christ [18].
The name of the biblical character Lazarus has been used in the title of related
Conclusion
Further case reports are needed. We would propose that future authors use the term `Lazarus phenomenon' in the title to make retrieval of such cases easier. It might also be possible to design animal models for the two most common mechanisms of the phenomenon (hyperinflation, hyperkalaemia).
It should be kept in mind that confirmation of death is an important duty of the medical profession. We agree with Linko et al. [3]that after cessation of CPR, each patient should be further monitored (at
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Restoration of spontaneous circulation after cessation of cardiopulmonary resuscitation
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Prolonged asystolic hyperkalemic cardiac arrest with no neurologic sequelae
Ann Emerg Med
(1994) Magic Johnson and Lazarus: the new syndromes
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Cited by (64)
A Case Report of Delayed Return of Spontaneous Circulation: Lazarus Phenomenon
2016, American Journal of MedicineCitation Excerpt :Lazarus phenomenon dates back in the medical literature to 1982.1 Although few cases have been published, there is reason to believe it is underreported, likely because of fear of legal repercussions or stigma.2 There are multiple proposed mechanisms of autoresuscitation.
International perspective on the diagnosis of death
2012, British Journal of AnaesthesiaCitation Excerpt :Canada and the UK have adopted a more conservative 5 min standard,8 39 while in Italy 20 min is required.46 The Lazarus phenomenon of auto-resuscitation, as described in the literature, appears to occur only in the context of failed or inadvertently continued CPR (e.g. continuing mechanical ventilation in a patient declared ‘dead’) and not after the planned withdrawal of life-sustaining treatment.47 A recent systematic review could identify only eight cases of return of spontaneous circulation with ECG monitoring and exact times recorded, all followed failed CPR; in one case return of spontaneous circulation occurred at 3 min, in six cases at 5 min and in one case (from 1996) at 7 min.48
Non heartbeating donation - The heart of the matter
2010, Current Anaesthesia and Critical CareCitation Excerpt :Death in NHB donors has been defined as irreversible cessation of circulatory and respiratory function.13 This notion has been hard to support particularly when there have been reports of auto resuscitation (Lazarus phenomenon)27,28 and of instances where extra corporeal cardio-pulmonary support was able to revive full neurological function in cardiac arrest victims.29 Therefore understandably, this issue has been fiercely debated on the premise that whether the donor is certainly dead before the organs are procured or can the procurement process directly cause the death?30
The authors reply
2010, Pediatric Critical Care MedicineA call for full public disclosure and moratorium on donation after cardiac death in children
2010, Pediatric Critical Care Medicine
- 1
This paper has been presented in part as a poster at both the 10th European Congress of Anaesthesiology in Frankfurt/Main, July 1998, and the 4th Pan-European Conference on Emergency Medical Systems in Opatija/Croatia, August 1998.