Can resuscitate someone from death

“Lazarus phenomenon” is real

Mysterious resurrection: There are people who seem to die after a failed resuscitation, but then wake up again from death - without the intervention of the doctors. Doctors have now investigated what is behind this "Lazarus phenomenon". According to this, such a spontaneous “resurrection” after resuscitation could occur more frequently than expected. And around a third of these Lazarus patients survive the temporary death despite cardiac arrest without consequential damage or failures.

A patient suffers cardiac arrest, he no longer breathes and his signs of life have also disappeared. But although emergency physicians fight for his life for 20 or 30 minutes, maybe even shock him with electric shocks, their efforts are in vain: the patient does not react and is therefore declared dead. But then the miracle happens: several minutes or even hours later, the supposedly dead person suddenly wakes up again - all by himself and without medical help.

What is behind the Lazarus phenomenon?

What sounds like a miracle is reality - and is not so rare: In 1982 doctors reported for the first time about such a "Lazarus patient". And surveys show that 37 to 50 percent of all intensive care and emergency doctors have experienced such a case before. That is why Les Gordon of the Royal Lancaster Infirmary in England and his colleagues have investigated the Lazarus phenomenon and its accompanying circumstances more closely. To do this, they evaluated case descriptions in the specialist literature published since 1982.

The result: So far, the Lazarus phenomenon has been described in 63 patients. All of them had been given up after a failed cardiopulmonary resuscitation and had then spontaneously developed signs of life and circulatory activity again. “However, based on our analyzes, we suspect that Lazarus syndrome occurs much more frequently than it appears in the literature,” says Gordon. Because if a patient who they have declared dead is suddenly still alive, many doctors fear legal consequences and therefore do not report it.

"Resurrection" usually after five to ten minutes

What is striking: "After a death without prior resuscitation measures, such cases do not seem to occur," said the researchers. This suggests that these measures play a decisive role. “It is possible that the medical measures carried out during the resuscitation are effective, but for whatever reason they take effect after a delay,” the scientists speculate.

In addition, the "resurrection" for most Lazarus patients takes place five to ten minutes after the end of the resuscitation. Gordon and his team therefore recommend monitoring patients who have already been declared dead for at least ten minutes using an electrocardiogram (ECG) - five minutes have been the guideline so far. "But there were also cases in which the signs of life did not appear until several hours after the supposed death," report Gordon and his colleagues.

One third has no permanent damage

Also surprising: a good third of the Lazarus patients survived this "temporary death" without serious consequences - although their heart did not beat and thus their brain and organs did not receive sufficient oxygen. "Of the 63 patients, 22 were discharged from the hospital, 18 of them without permanent neurological damage," said Gordon and his colleagues. However, the remaining 41 affected died after all - mostly due to severe brain damage.

“The fact that the majority of the survivors showed no consequential damage is of the utmost importance,” emphasizes co-author Mathieu Pasquier from the Lausanne University Hospital. Possibly this suggests that in some cases the brain and other organs remain functional longer even after cardiac arrest. This fits in with the fact that scientists recently were able to partially revive the brains of dead pigs even after hours.

Recommendations for resuscitation

On the basis of these observations, Gordon and his colleagues give a number of recommendations for resuscitation: If the cardiac arrest, resuscitation should be continued for at least 20, preferably 30 minutes. Resuscitation should not be stopped immediately after an apparently unsuccessful electric shock defibrillation because a heartbeat can start again with a delay.

Another factor that seems to favor a Lazarus phenomenon is ventilation under excessive pressure. Because this makes natural exhalation difficult and the lungs inflate. This can inhibit blood flow and heartbeat, faking death. "Such a high intrathoracic pressure seems to be one of the trigger mechanisms in many of the Lazarus cases," explain Gordon and his colleagues.

"Considerable Consequences"

According to the scientists, the Lazarus phenomenon is an important indication that resuscitation and the determination of death in everyday clinical practice should be optimized even further. "While the cases seem few, the consequences are considerable when you consider the medical staff involved, the relatives, the legal consequences, and the number of patients who need resuscitation," they state. (Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2020; doi: 10.1186 / s13049-019-0685-4)

Source: Eurac Research

July 9, 2020

- Nadja Podbregar