[Lazarus phenomenon: spontaneous resuscitation]

Area of Science:

• Medicine
• Cardiology
• Critical Care Medicine

Background:

• Electromechanical dissociation (EMD) is a state where the heart shows organized electrical activity but no mechanical contraction.
• The Lazarus phenomenon, or autoejection, is a rare occurrence of spontaneous return of circulation after cessation of cardiopulmonary resuscitation.
• Intraoperative cardiac arrest presents unique challenges for resuscitation and post-event management.

Observation:

• A 94-year-old woman experienced massive hemorrhage during duodenal perforation repair surgery.
• Following initial resuscitation, the patient developed EMD and cardiopulmonary resuscitation was initiated.
• After 40 minutes of resuscitation, measures were withdrawn, yet spontaneous circulation returned within minutes.

Findings:

• The Lazarus phenomenon was observed in a surgical patient following EMD and cessation of resuscitation.
• This intraoperative event suggests potential differences in pathophysiology compared to non-surgical Lazarus phenomenon cases.
• The patient survived the initial event but later succumbed to septic shock and multiorgan failure.

Implications:

• The Lazarus phenomenon may be underreported, particularly in surgical settings.
• Prudent monitoring and a cautious approach are essential before certifying death, especially after intraoperative cardiac arrest.
• Establishing a national database for intraoperative Lazarus phenomenon events could improve understanding and management protocols.