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The Lazarus phenomenon.

Vedamurthy Adhiyaman1, Sonja Adhiyaman, Radha Sundaram

  • 1Department of Geriatric Medicine, Glan Clwyd District Hospital, Rhyl, Denbighshire LL18 5UJ, UK. vedamurthy.adhiyaman@cd-trust.wales.nhs.uk

Journal of the Royal Society of Medicine
|December 11, 2007
PubMed
Summary
This summary is machine-generated.

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The Lazarus phenomenon, where patients spontaneously resume circulation after cardiac arrest, is real but underreported. Explanations involve auto-positive end-expiratory pressure and impaired venous return, suggesting brief apnea trials before declaring death.

Area of Science:

  • Medical Science
  • Emergency Medicine
  • Physiology

Background:

  • The Lazarus phenomenon, or autoresuscitation, is a rare but documented occurrence following cardiopulmonary arrest.
  • Existing scientific explanations for this phenomenon remain inadequate.
  • Underreporting likely contributes to its perceived rarity.

Purpose of the Study:

  • To explore potential physiological mechanisms behind the Lazarus phenomenon.
  • To provide evidence-based recommendations for managing patients with suspected or potential Lazarus phenomenon.
  • To improve the accuracy of death pronouncement in critical care settings.

Main Methods:

  • Review of existing literature on the Lazarus phenomenon and related physiological events.
  • Analysis of proposed mechanisms including auto-positive end-expiratory pressure (PEEP) and impaired venous return.

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  • Consideration of clinical implications for resuscitation protocols.

    • Main Results:

    • Auto-PEEP and impaired venous return are plausible explanations in some Lazarus phenomenon cases.
    • Dynamic hyperinflation may contribute to the phenomenon in patients with pulseless electrical activity (PEA) or asystole.
    • Spontaneous Return of Circulation (ROSC) typically occurs within 10 minutes of cardiopulmonary resuscitation (CPR) cessation.

    Conclusions:

    • A brief period of apnea (30-60 seconds) should be considered before terminating resuscitation efforts in PEA or asystole.
    • Passive monitoring for at least 10 minutes after CPR cessation is recommended before confirming death to account for potential Lazarus phenomenon.
    • Further research is needed to fully elucidate the mechanisms and optimize management strategies for the Lazarus phenomenon.