When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

Sharma, Munish; Chandna, Megha; Nguyen, The Hung; Vakil, Abhay; Franco, Rene; Ratnani, Iqbal; Varon, Joseph; Surani, Salim

doi:10.1155/2020/8841983

Cited by 3 publications

(5 citation statements)

References 8 publications

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“…These studies showed that autoresuscitation may occur after five minutes of observation following terminated CPR, occurring up to 20 min after terminated CPR in one case report. 28 A large observational study supported these case report observations though important confounders were identified in the two autoresuscitation events occurring beyond five minutes of observation, leading to low certainty in the evidence. 7 One patient (autoresuscitation at six minutes) did not have the ventilation bag disconnected from the endotracheal tube, and another patient (autoresuscitation at eight minutes) had continuation of norepinephrine infusion after CPR cessation.…”

Section: Discussionmentioning

confidence: 75%

“…Ten case reports (71%) described autoresuscitation events in a total of 11 patients following unsuccessful CPR. 28 – 30 , 33 – 39 Six patients had an out-of-hospital cardiac arrest (OHCA) 29 , 33 , 34 , 37 , 39 and five an in-hospital cardiac arrest. 28 , 30 , 35 , 36 , 38 Most patients were adults ( n = 10; age range, 25–79 yr).…”

Section: Resultsmentioning

confidence: 99%

“… 28 – 30 , 33 – 39 Six patients had an out-of-hospital cardiac arrest (OHCA) 29 , 33 , 34 , 37 , 39 and five an in-hospital cardiac arrest. 28 , 30 , 35 , 36 , 38 Most patients were adults ( n = 10; age range, 25–79 yr). The one pediatric case report described an 18 month-old with unsuccessful CPR following OHCA.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Autoresuscitation after circulatory arrest: an updated systematic review

Zorko

Shemie

Hornby

et al. 2023

Can J Anesth/J Can Anesth

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Purpose Current practice in organ donation after death determination by circulatory criteria (DCD) advises a five-minute observation period following circulatory arrest, monitoring for unassisted resumption of spontaneous circulation (i.e., autoresuscitation). In light of newer data, the objective of this updated systematic review was to determine whether a five-minute observation time was still adequate for death determination by circulatory criteria. Source We searched four electronic databases from inception to 28 August 2021, for studies evaluating or describing autoresuscitation events after circulatory arrest. Citation screening and data abstraction were conducted independently and in duplicate. We assessed certainty in evidence using the GRADE framework. Principal findings Eighteen new studies on autoresuscitation were identified, consisting of 14 case reports and four observational studies. Most studies evaluated adults ( n = 15, 83%) and patients with unsuccessful resuscitation following cardiac arrest ( n = 11, 61%). Overall, autoresuscitation was reported to occur between one and 20 min after circulatory arrest. Among all eligible studies identified by our reviews ( n = 73), seven observational studies were identified. In observational studies of controlled withdrawal of life-sustaining measures with or without DCD ( n = 6), 19 autoresuscitation events were reported in 1,049 patients (incidence 1.8%; 95% confidence interval, 1.1 to 2.8). All resumptions occurred within five minutes of circulatory arrest and all patients with autoresuscitation died. Conclusion A five-minute observation time is sufficient for controlled DCD (moderate certainty). An observation time greater than five minutes may be needed for uncontrolled DCD (low certainty). The findings of this systematic review will be incorporated into a Canadian guideline on death determination. Study registration PROSPERO (CRD42021257827); registered 9 July 2021. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-023-02411-8.

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Section: Discussionmentioning

confidence: 75%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Autoresuscitation after circulatory arrest: an updated systematic review

Zorko

Shemie

Hornby

et al. 2023

Can J Anesth/J Can Anesth

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“…One of them was cardiac arrest in the operating room during laparotomy in a 33-year-old patient who had previously had a ventriculoperitoneal shunt after meningioma surgery and now had an "acute abdomen" due to a ventriculoperitoneal shunt. Computed tomography of the head showed areas of acute infarction involving the brainstem and cerebellar hemispheres, as well as moderate enlargement of the ventricular system with left-sided intraventricular hemorrhage [43]. During the procedure, the patient developed bradycardia and asystole.…”

Section: The Latest Cases Of the Lazarus Phenomenonmentioning

confidence: 98%

Lazarus Phenomenon or the Return from the Afterlife—What We Know about Auto Resuscitation

Rzeźniczek

Gaczkowska

Kluzik

et al. 2023

JCM

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Autoresuscitation is a phenomenon of the heart during which it can resume its spontaneous activity and generate circulation. It was described for the first time by K. Linko in 1982 as a recovery after discontinued cardiopulmonary resuscitation (CPR). J.G. Bray named the recovery from death the Lazarus phenomenon in 1993. It is based on a biblical story of Jesus’ resurrection of Lazarus four days after confirmation of his death. Up to the end of 2022, 76 cases (coming from 27 countries) of spontaneous recovery after death were reported; among them, 10 occurred in children. The youngest patient was 9 months old, and the oldest was 97 years old. The longest resuscitation lasted 90 min, but the shortest was 6 min. Cardiac arrest occurred in and out of the hospital. The majority of the patients suffered from many diseases. In most cases of the Lazarus phenomenon, the observed rhythms at cardiac arrest were non-shockable (Asystole, PEA). Survival time after death ranged from minutes to hours, days, and even months. Six patients with the Lazarus phenomenon reached full recovery without neurological impairment. Some of the causes leading to autoresuscitation presented here are hyperventilation and alkalosis, auto-PEEP, delayed drug action, hypothermia, intoxication, metabolic disorders (hyperkalemia), and unobserved minimal vital signs. To avoid Lazarus Syndrome, it is recommended that the patient be monitored for 10 min after discontinuing CPR. Knowledge about this phenomenon should be disseminated in the medical community in order to improve the reporting of such cases. The probability of autoresuscitation among older people is possible.

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“…Activities stopped, but after 30s, presence of a pulse was noticed. 10 So far 17 reported cases of Lazarus phenomenon in last 10 years are summarized in Table . Cases described include both in-hospital and out-of-hospital arrests.…”

Section: Notable Casesmentioning

confidence: 99%

Lazarus syndrome-a miraculous revival

V.,

Jose K.

2024

Int J Community Med Public Health

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The Lazarus syndrome, named after the biblical account of Lazarus, being raised from the dead, refers to the uncommon occurrence of spontaneous recovery of circulation following failed resuscitation attempts. This review article delves into the historical foundations, underlying mechanisms, prominent instances, disputes, ethical concerns, medical interventions, and psychological consequences of Lazarus syndrome. Despite being recorded in medical literature, the mechanisms underlying this condition are not well known. Possible explanations include medication-related delays, hyperkalemia, reperfusion damage, myocardial shock, and brainstem reflexes. While Lazarus syndrome calls into question our notion of life and death, it also raises ethical concerns about death verification, informed consent, quality of life, resource allocation, and cultural values therapies include diagnosing underlying reasons, enhanced cardiac life support, extracorporeal membrane oxygenation, therapeutic hypothermia, and ongoing monitoring. The psychological burden on healthcare staff and families is significant, necessitating assistance and coping measures. Understanding and managing the intricacies of Lazarus syndrome is critical to the well-being of everyone concerned.

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When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

Cited by 3 publications

References 8 publications

Autoresuscitation after circulatory arrest: an updated systematic review

Autoresuscitation after circulatory arrest: an updated systematic review

Lazarus Phenomenon or the Return from the Afterlife—What We Know about Auto Resuscitation

Lazarus syndrome-a miraculous revival

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