Autoresuscitation (Lazarus phenomenon) after termination of cardiopulmonary resuscitation - a scoping review

Abstract

Background: Autoresuscitation describes the return of spontaneous circulation after termination of resuscitation (TOR) following cardiac arrest (CA). We aimed to identify phenomena that may lead to autoresuscitation and to provide guidance to reduce the likelihood of it occurring. Materials and methods: We conducted a literature search (Google Scholar, MEDLINE, PubMed) and a scoping review according to PRISMA-ScR guidelines of autoresuscitation cases where patients undergoing CPR recovered circulation spontaneously after TOR with the following criteria: 1) CA from any cause; 2) CPR for any length of time; 3) A point was reached when it was felt that the patient had died; 4) Staff declared the patient dead and stood back. No further interventions took place; 5) Later, vital signs were observed. 6) Vital signs were sustained for more than a few seconds, such that staff had to resume active care. Results: Sixty-five patients with ROSC after TOR were identified in 53 articles (1982-2018), 18 (28%) made a full recovery. Conclusions: Almost a third made a full recovery after autoresuscitation. The following reasons for and recommendations to avoid autoresuscitation can be proposed: 1) In asystole with no reversible causes, resuscitation efforts should be continued for at least 20 min; 2) CPR should not be abandoned immediately after unsuccessful defibrillation, as transient asystole can occur after defibrillation; 3) Excessive ventilation during CPR may cause hyperinflation and should be avoided; 4) In refractory CA, resuscitation should not be terminated in the presence of any potentially-treatable cardiac rhythm; 5) After TOR, the casualty should be observed continuously and ECG monitored for at least 10 min.

Erweiterte lebensrettende Maßnahmen für Erwachsene

“…Eine unkontrollierte Spende nach dem Kreislauftod ist ein zeitkritischer, ressourcenintensiver, komplexer und ethisch herausfordernder Prozess [ 441 , 442 ]. Nach Abschluss umfassender Wiederbelebungsbemühungen und Bestätigung des Todes wird eine Zeitspanne ohne Berührung des Toten eingehalten, um die Möglichkeit einer automatischen Wiederbelebung auszuschließen [ 443 ]. Die Verfahren zur Organerhaltung werden dann sofort gestartet und fortgesetzt, während die Zustimmung der Familie zur Organtransplantation eingeholt wird, und die Organe auf ihre Eignung für eine Spende geprüft [ 444 – 446 ].…”

Lazarus Phenomenon: Return of Spontaneous Circulation After Cessation of Prolonged Cardiopulmonary Resuscitation in a Patient With COVID-19

“…Cardiovascular factors include: coronary perfusion pressure (CPP) as low as 15mmHg can produce a return of spontaneous circulation after asystole; intrinsic vasomotor function of capacitance and resistance blood vessels may maintain CPP so that even when resuscitation has ceased, CPP may be high enough to restart the heart [ 7 ]. Return of myocardial function following termination of resuscitation (TOR): myocardial reperfusion due to spontaneous dislodging of endovascular plaque from a coronary artery [ 7 ].…”

When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

“…This case highlights a rare entity in medicine literature called autoresuscitation or Lazarus phenomenon which can be identified as the return of spontaneous circulation that occurred after cessation of CPR following cardiac arrest [ 3 ]. It has been speculated that this is more so an underreported phenomenon than a rare occurrence.…”

“…It has been speculated that this is more so an underreported phenomenon than a rare occurrence. Nonetheless, after the literature search, 1372 publications were found and 63 patients whose outcomes were provided [ 3 ]. What makes this case unique is the multiple medical comorbidities of the patient that could factor including brain stem infarct complicated by VP shunt with prior craniotomy, hypothyroidism, and adrenal insufficiency.…”