Do we need standardized management after Termination-of-Resuscitation Attempts? Autoresuscitation in a 67-year-old woman: a case report

Abstract

Background: Autoresuscitation is the phenomenon of spontaneous return of circulation after cessation of CPR, also known as the Lazarus syndrome or phenomenon. Most of the evidence is based on case reports and a few systematic reviews, which focus on the mechanisms leading to autoresuscitation or the timing of it. The occurrence of autoresuscitation may lead to self-reproach and dismay in affected emergency personnel and may rise questions about the correct procedure after terminating resuscitative efforts. In contrast to existing cardiac arrest guidelines there is no standardized approach to terminating resuscitative attempts. Case: We report a case of out of hospital autoresuscitation in a 67-year-old female after 60 minutes of advanced cardiac life support. After shock refractory ventricular fibrillation as well as pulseless ventricular tachycardia, we recorded pulseless electrical activity and fixed pupils. Since the patient was in the ambulance at the time the cardiopulmonary resuscitation was abandoned, a discussion with the responsible medical authorities followed. It was decided that the body should be taken to the hospital for further legal medical examination. In the meantime, all monitoring devices were removed. On arrival the patient surprisingly showed signs of life, so that she was immediately taken to the emergency department. Due to the suggestive history, a coronary angiography was performed, showing three-vessel coronary heart disease which necessitated surgical intervention. Before transferring the patient to a cardiac surgery center, sedation was reduced to investigate neurological damage. Ten days after ACBP surgery the patient was transferred to the cardiological ward and a week later she was finally discharged to neurological rehabilitation. Conclusion : As already proposed by existing literature, there should be at least a 10-minute interval of close monitoring after abandoning CPR. Transport of a deceased patient should only take place after secure signs of death, such as postmortem lividity, can be detected. In our case we were confronted with a shock refractory shockable rhythm which deteriorated into a pulseless electrical activity. Further investigation is needed to determine which patients are most likely to benefit from an extended observation period. Our case reports highlights the difficulties in death declaration and the importance of close monitoring after abandoning CPR.