Lazarus syndrome

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 38 times since 1982.^[3][4] Also called Lazarus phenomenon, it takes its name from Lazarus who, in the New Testament of The Bible, was raised from the dead by Jesus.^[5]

Occurrences of the syndrome are extremely rare and the causes are not well understood. One hypothesis 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.^[5]

Cases

• Daphne Banks overdosed on drugs in Huntingdon, England on 31 December 1996. She was declared dead at Hinchingbrooke Hospital early the next day. She was found snoring at a mortuary 34 hours later.^[6]
• A 27-year-old man in the UK collapsed after overdosing on heroin and cocaine. Paramedics gave him an injection, and he recovered enough to walk to the ambulance. He went into cardiac arrest in transit. 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.^[5]
• A 66-year-old man suffering from a suspected abdominal aneurysm who, during treatment for this condition, 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]
• According to a 2002 article in the journal Forensic Science International, a 65-year-old prelingually deaf Japanese male was found unconscious in the foster home he lived in. Cardiopulmonary resuscitation was attempted on the scene by home staff, emergency medical personnel and also in the emergency department of the hospital and included appropriate medications and defibrillation. He was declared dead after attempted resuscitation. However, a policeman found the person moving in the mortuary after 20 minutes. The patient survived for 4 more days.^[7]
• Judith Johnson, 61, went into cardiac arrest at Beebe Medical Center in Lewes, Delaware, United States, in May 2007. She was given "multiple medicines and synchronized shocks", but never regained a pulse. She was declared dead at 8:34 p.m. 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.^[4]
• Michael Wilkinson, 23, was found collapsed in Preston, England on 1 February 2009. He was sent to Royal Preston Hospital in Lancashire where medical staff gave him drugs and worked on him for 15 minutes before declaring him dead. Half an hour later, a pulse was found. He survived for two days, and a post-mortem examination found an undiagnosed heart condition.^[8]
• 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.^[9][10]
• A 65-year-old man in Malaysia came back to life two-and-a-half hours after doctors at Seberang Jaya Hospital, Penang, pronounced him dead. He died three weeks later.^[11]
• Anthony Yahle, 37, in Bellbrook, Ohio, USA, was breathing abnormally at 4 a.m. on 5 August 2013, and could not be woken. He was given CPR, and first responders shocked him several times and found a heartbeat. That afternoon, he coded for 45 minutes at Kettering Medical Center and was pronounced dead. When his son arrived at the hospital, he noticed a heartbeat on the monitor that was still attached. Resuscitation efforts resumed, and the patient was revived.^[12]
• Walter Williams, 78, from Lexington, Mississippi, United States, was at home when his hospice nurse called a coroner who arrived and declared him dead at 9 p.m. on 26 February 2014. Once at a funeral home, he was found to be moving, possibly resuscitated by a defibrillator implanted in his chest.^[13] The next day he was well enough to be talking with family, but died fifteen days later.^[14]

Implications

The Lazarus phenomenon raises ethical issues for physicians, who must determine when medical death has occurred, resuscitation efforts should end, and postmortem procedures such as autopsies and organ harvesting may take place.^[2]

Medical literature has recommended observation of a patient's vital signs for five to ten minutes after cessation of resuscitation before certifying death.^[5]

See also

• Lazarus sign
• Lazarus taxon
• Near-death experience
• Premature burial
• Suspended animation
• The Lazarus Phenomenon Documentary

References

1. Hornby K, Hornby L, Shemie SD (May 2010). "A systematic review of autoresuscitation after cardiac arrest". Crit. Care Med. 38 (5): 1246–53. doi:10.1097/CCM.0b013e3181d8caaa. PMID 20228683.
2. Ben-David M.D., Bruce; et al. (2001). "Survival After Failed Intraoperative Resuscitation: A Case of "Lazarus Syndrome"". Anesthesia & Analgesia 92 (3): 690–692. doi:10.1213/00000539-200103000-00027. PMID 11226103. Retrieved 2014-07-28.
3. Adhiyaman, Vedamurthy; Adhiyaman, Sonja; Sundaram, Radha. "The Lazarus phenomenon". National Center for Biotechnology Information. Journal of the Royal Society of Medicine. Retrieved 4 January 2014.
4. "Woman Declared Dead, Still Breathing in Morgue". Fox News. 2008-10-07. Retrieved 2014-07-28.
5. Walker, A.; H. McClelland; J. Brenchley (2001). "The Lazarus Documentary following recreational drug use". Emerg Med J 18 (1): 74–75. doi:10.1136/emj.18.1.74. PMC 1725503. PMID 11310473. Retrieved 2014-07-28.
6. Derbyshire, David (16 October 2012). "Lazarus Syndrome: Or how - as one British woman's just proved - waking from the dead is more common than you think". MailOnline (London). Archived from the original on 2013-05-20.
7. Maeda, H; Fujita, M. Q.; Zhu, B. L.; Yukioka, H; Shindo, M; Quan, L; Ishida, K (2002). "Death following spontaneous recovery from cardiopulmonary arrest in a hospital mortuary: 'Lazarus phenomenon' in a case of alleged medical negligence". Forensic Science International 127 (1–2): 82–7. doi:10.1016/s0379-0738(02)00107-x. PMID 12098530.
8. "Lazarus syndrome man pronounced dead comes back to life for two days". MailOnline (London). 11 June 2009. Retrieved 1 March 2014.
9. "Embalmer finds ‘dead’ woman really alive". Bogota: NBC News. 2010-02-17. Retrieved 2014-07-28.
10. Salazar, Hernando. "¿Colombiana experimentó Síndrome de Lázaro?". BBC Online (in Spanish). Retrieved 26 December 2010.
11. Vinesh, Derrick (26 April 2011). "Resurrection man dies". The Star Online. Retrieved 2014-07-28.
12. Lupkin, Sydney (22 August 2013). "Ohio Man Declared Dead Comes Back to Life". Retrieved 4 January 2014.
13. McLaughlin, Eliott (28 February 2014). "Dead Mississippi man begins breathing in embalming room, coroner says". CNN. Retrieved 28 February 2014.
14. Ford, Dana (13 March 2014). "Mississippi man who awoke in body bag dies two weeks later". CNN. Retrieved 13 March 2014.