Lazarus syndrome or autoresuscitation after failed cardiopulmonary resuscitation[1] is the spontaneous return of circulation after failed attempts at resuscitation.[2] Its occurrence has been noted in medical literature at least 25 times since 1982.[3] Also called Lazarus phenomenon, it takes its name from Lazarus who, in the New Testament account, was raised from the dead by Jesus.[4]
Occurrences of the syndrome are extremely rare and the causes are not well understood. One theory for the phenomenon is that a chief factor (though not the only one) is the buildup of pressure in the chest as a result of cardiopulmonary resuscitation (CPR). The relaxation of pressure after resuscitation efforts have ended is thought to allow the heart to expand, triggering the heart's electrical impulses and restarting the heartbeat.[2] Other possible factors are hyperkalemia or high doses of epinephrine.[4]
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One example is a 61-year-old woman from Delaware, USA, who was given "multiple medicines and synchronized shocks", but never regained a pulse. She was declared dead but was discovered in the morgue to be alive and breathing. She sued the medical center where it happened for damages due to physical and neurological problems stemming from the event.[3]
Another case is a 66-year-old man suffering from a suspected abdominal aneurysm. During treatment for this condition, the patient suffered cardiac arrest and received chest compressions and defibrillation shocks for 17 minutes. Vital signs did not return; the patient was declared dead and resuscitation efforts ended. Ten minutes later, the surgeon felt a pulse. The aneurysm was successfully treated and the patient fully recovered with no lasting physical or neurological problems.[2]
A 27-year-old man in the UK went into cardiac arrest after overdosing on heroin and cocaine. After 25 minutes of resuscitation efforts, the patient was verbally declared dead. About a minute after resuscitation ended, a nurse noticed a rhythm on the heart monitor and resuscitation was resumed. The patient recovered fully.[4]
An 18-year-old woman in Missouri, USA, attempted suicide by overdosing on sleeping medication. Resuscitation was attempted, but failed, and she was declared dead. Seven minutes later, her heart started beating and she started breathing on her own again, though she was comatose. The woman regained consciousness 5 days later and was oblivious to what had happened.
A 45 year-old woman in Colombia was pronounced dead, as there were no vital signs showing she was alive. Later, a funeral worker noticed the woman moving and alerted his co-worker that the woman should go back to the hospital.[5][6]
A 65-year old man in Malaysia came back to life two-and-a-half hours after doctors at a Penang hospital pronounced him dead. He died three weeks later.[7]
The Lazarus Syndrome raises ethical issues for doctors, who must determine when medical death has occurred, resuscitation efforts should end, and post-mortem procedures such as autopsies and organ harvesting may take place.[2] One doctor wrote, "Perhaps it is a supreme hubris on our part to presume that we can reliably distinguish the reversible from the irreversible, or the salvageable from the nonsalvageable."[2]
Medical literature has recommended observation of a patient's vital signs for five to ten minutes after cessation of resuscitation before certifying death.[4]
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