SHM Converge Scientific Abstract ePoster Gallery-A Second Lease on Life: Case of the Lazarus Phenomenon

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This case report describes a rare example of the Lazarus phenomenon, or autoresuscitation after a patient has been declared dead. The patient was a 53-year-old man with hypertension, diabetes, peripheral vascular disease, abdominal aortic aneurysm, and non-small cell lung cancer who presented with headaches, dizziness, and gait instability. Imaging showed a left cerebellar mass with edema and fourth ventricle effacement, consistent with metastatic disease.<br /><br />During hospitalization, he abruptly collapsed during repeat head imaging. He became unresponsive and underwent CPR, intubation, and ACLS for 27 minutes. He was pronounced dead after resuscitation efforts failed, but about five minutes later he spontaneously resumed breathing and returned to sinus rhythm. He was transferred back to the ICU without obvious neurologic deficits and had no clear cardiac cause identified on workup. Unfortunately, he later died on hospital day 16 from postoperative complications.<br /><br />The discussion highlights that the Lazarus phenomenon is rare and likely underreported. Proposed explanations include reversible causes of cardiac arrest, prolonged CPR, and especially the effects of positive pressure ventilation causing lung hyperinflation, increased intrathoracic pressure, reduced venous return, and delayed circulation of resuscitation medications. When ventilation stops after termination of resuscitation, intrathoracic pressure may fall, preload may improve, and spontaneous circulation may return. In this case, common reversible causes such as ischemia, arrhythmia, electrolyte abnormalities, and pulmonary embolism were not supported by available testing.<br /><br />The authors emphasize the importance of continued observation after termination of resuscitation to avoid false death pronouncements, as well as careful attention to ventilation technique during CPR.

Asset Subtitle

Angel Chen

Meta Tag

Author List Angel Chen, Matthew Au

Category Clinical Vignettes

Concept Lazarus Phenomenon

Concept Termination of Resuscitation

Concept Cardiac Arrest

Concept Reversible Cause

Concept Ventilation-Induced Hyperinflation

Distinguished Non-Finalist

Presenter Organization Rutgers New Jersey Medical School

Presenting Author Angel Chen

Track Adult

Keywords

Lazarus phenomenon

autoresuscitation

false death pronouncement

cardiopulmonary resuscitation

positive pressure ventilation

intrathoracic pressure

metastatic cerebellar mass

non-small cell lung cancer

return of spontaneous circulation

case report

Lazarus Phenomenon

Termination of Resuscitation

Cardiac Arrest

Reversible Cause

Ventilation-Induced Hyperinflation