The Lazarus phenomenon: spontaneous cardioversion after termination of resuscitation in a Scottish hospital

A 66-year-old man suffered a ventricular fibrillation cardiac arrest after an episode of chest pain. Despite advanced life support, his condition deteriorated; the situation was considered irrecoverable and resuscitation was discontinued. The patient was observed for about 5 min with irregular agona...

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Bibliographic Details
Published in:BMJ case reports 2017-04, Vol.2017, p.bcr-2017-219203
Main Authors: Spowage-Delaney, Benjamin, Edmunds, Christopher T, Cooper, Jamie G
Format: Article
Language:English
Subjects:
Aged
Airway management
Cardiac arrest
Cardiology
Cardiopulmonary Resuscitation
Cardioversion
Catheters
CPR
Drug dosages
Electric Countershock
Emergency medical care
Emergency Medical Services
Heart attacks
Humans
Hyperventilation
Male
Myocardial Infarction - diagnosis
Myocardial Infarction - surgery
Paramedics
Patients
Percutaneous Coronary Intervention - methods
Pulmonary arteries
Recovery of Function
Remission, Spontaneous
Systematic review
Treatment Outcome
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
United Kingdom
Veins & arteries
Ventilators
White
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Summary:A 66-year-old man suffered a ventricular fibrillation cardiac arrest after an episode of chest pain. Despite advanced life support, his condition deteriorated; the situation was considered irrecoverable and resuscitation was discontinued. The patient was observed for about 5 min with irregular agonal gasping respirations evident but no palpable pulse. A gradual increase in the regularity of breathing pattern heralded the return of spontaneous circulation. An inferior myocardial infarction was diagnosed. Primary percutaneous coronary intervention was performed. The patient was discharged from hospital after 9 days with no neurological sequelae. There are several possible mechanisms to explain the Lazarus phenomenon including auto-positive end expiratory pressure and delayed drug actions, but cases are rarely reported in the medical literature. After discontinued resuscitation, we suggest consideration should be given to a period of continued monitoring. However, evidence is limited and prospective studies would be welcome to allow firmer recommendations.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2017-219203