Elsevier

Resuscitation

Volume 39, Issues 1–2, November 1998, Pages 125-128
Resuscitation

Unexpected return of spontaneous circulation after cessation of resuscitation (Lazarus phenomenon)1

https://doi.org/10.1016/S0300-9572(98)00119-1Get rights and content

Abstract

Since 1982, more than 20 patients with return of spontaneous circulation after cessation of cardiopulmonary resuscitation (Lazarus phenomenon) have been published. We report on another case here. Such cases are probably underreported due to medicolegal concerns. After cessation of resuscitation, each patient should be further monitored for at least 10 min to detect a possible Lazarus phenomenon.

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

References (26)

  • S.E Lapinsky et al.

    Auto-PEEP and electromechanical dissociation

    New Engl J Med

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  • D.J Hill

    The Lazarus phenomenon re-revisited: II

    Anesthesiology

    (1993)
  • DD Koblin

    The Lazarus phenomenon re-revisited: I

    Anesthesiology

    (1993)
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    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.

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