As first responders, we know to “expect the unexpected.” But few medical mysteries are as perplexing as the Lazarus Phenomenon, also known as Lazarus syndrome, unassisted return of spontaneous circulation (ROSC) or autoresuscitation after termination of cardiopulmonary resuscitation. In this article, we’ll delve into the Mysteries of the Lazarus Phenomenon, shedding light on its definition, possible causes, and how to respond should you be lucky (or unlucky?) enough to encounter this rare but real medical marvel.
What Is the Lazarus Phenomenon?
The Lazarus Phenomenon, put most simply, is when a person comes back to life after resuscitation efforts have been terminated or sometimes even after being pronounced clinically dead. Autorecusciatition specifically refers to a patient who regains signs of life after failing to respond to life-saving resuscitation efforts.
The Lazarus Effect has been discovered anywhere from moments to even hours after death, when the patient, thought to be deceased, spontaneously regains a pulse and/or starts breathing… without any help from medical professionals!
How Common is the Lazarus Phenomenon?
Lazarus Phenomenon is exceedingly rare. It’s impossible to know how many cases of autoresuscitation go unreported. But we know that the phenomenon first gained attention in 1982 with less than 100 confirmed cases globally to date.
In 1993, J G Bray Jr. published a case study and coined the term “Lazarus Phenomenon” to describe this medical mystery. The Phenomenon is aptly named after a story from the Bible. Lazarus, a faithful follower and friend, is miraculously raised from the dead by Jesus after being entombed for four days.
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Which Patients Are Most Likely to Experience the Lazarus Phenomenon?
The Lazarus Phenomenon can impact anyone. Of the 65 cases published by Les Gordon et al. (2020), the youngest patient reported was 9 months old, and the oldest was 97 years old. Sixy-eight percent of individuals experiencing the Lazarus Phenomenon were over the age of 60. Only 10 cases were identified in children, so the research suggests that autoresuscitation is more likely to occur within the elderly population but then again, so do more resuscitations in general.
Despite its rarity in medical documentation, this phenomenon has garnered significant attention not only within the healthcare community but also in popular culture. It’s not hard to understand why—especially with dramatic cases like that of Vincent Tolman, who described an out-of-body near-death experience after he “came back to life” inside a body bag.
The most mind-blowing part? No one, as of yet, has an explanation for why autoresuscitation happens. But, researchers have a few theories…
Why Does The Lazarus Phenomenon Occur?
Theory 1: Hyperventilation (Auto-PEEP)
One hypothesis suggests that Lazarus Phenomenon may stem from pressure buildup in the chest cavity from positive pressure ventilation (PPV) during CPR. When PPV is administered, air often enters the lungs rapidly before a previous ventilation can complete expiration, causing progressive air trapping. This can lead to hyperinflation, also called Positive End Expiratory Pressure (PEEP). When CPR ends, this accumulated pressure may gradually dissipate, allowing for the heart to start again moments later (and often unnoticed by medical personnel).
Theory 2: Delayed Action of Medications
Another theory posed revolves around the delayed effects of medications administered during resuscitation efforts, such as adrenaline. Researchers speculate that drugs injected into peripheral veins may not be adequately delivered to the heart due to poor venous return during CPR caused by hyperventilation. Once CPR concludes, the “overventilation” state may be reversed, leading to an autoresuscitation. It’s possible that these medications help to return circulation “spontaneously” even after the patient has been pronounced deceased.
Theory 3: Someone Made a Mistake
While an oversight in signs of life is not what the Lazarus Phenomenon appears to be, it’s important to at least acknowledge this theory. Could this be a reason behind what otherwise appears to be an autoresuscitation? Yes, of course. Because to err is human and all, right? Mistakes happen. But that is unlikely what is happening in many of the cases published. After all, how do you explain remaining in a ventricular rhythm for 75 minutes and receiving 25 defibrialtions that fail to restore the heart of one 68 year old woman only to deteriorate into asystole and staff discovering her alive 20 minutes after terminating the resuscitation? She was discharged home neurologically intact a few days later, able to care for herself.
Pinpointing the exact mechanisms behind the Lazarus Phenomenon remains challenging due to the scarcity of reported cases. Maybe healthcare providers are too ashamed to speak up when this happens, unaware of the Lazarus Phenomenon and fearing that they made a huge mistake?
Outcomes After the Lazarus Phenomenon Occurs
Of the 65 cases published by Les Gordon et al. (2020), 18 individuals (28%) achieved complete recovery.
Another study published in 2007 by Adhiyaman et al. reviewed 38 cases of the Lazarus Phenomenon. Of those 38 cases, 45% of individuals (17 people) recovered with “good neurological function.” This means that while they may have had lasting effects, they lived on for months or years after the experience.
According to the same study, 3 patients died in the hospital shortly after autoresuscitation due to sepsis and pulmonary embolism. But, 14 people (35% of those studied) were released from their hospital stay with no lasting neurological effects.
How Should You Respond to the Lazarus Phenomenon?
As first responders and emergency medical professionals, our first responsibility is to mitigate the risk of the Lazarus Phenomenon. It’s pretty unlikely that you will ever encounter the Lazarus Effect! But, you can reduce the likelihood by maintaining a high standard of care.
When administering resuscitation, we can make sure to:
- Refrain from immediate cessation of CPR post-defibrillation.
- Ensure adequate ventilation to prevent hyperinflation (Auto-PEEP) during CPR.
- Avoid hyperventilation to allow for effective circulation of medications.
- Utilize end-tidal Co2 to monitor for sudden spikes in capnometry and signs of ROSC.
- Passively monitor the patient for 10 minutes after terminating resuscitation efforts.
Implications of Lazarus Phenomenon
The reality of the Lazarus Phenomenon can be hard to swallow for emergency medical professionals who terminate resuscitation efforts all too often during their careers. While civilians often see the line between life and death as black and white, there are obviously a few shades of gray. We always want to know that we made the right call and did everything we could to save someone’s family or loved one. This topic can inspire some deep self-exploration about our own beliefs—how we feel and think about the mysteries of life and death and what we remain open minded to when it comes to the things we don’t quite understand.
While most first responders will never witness the Lazarus Phenomenon, it’s still imperative that we remain vigilant, adaptive, and compassionate. Especially in the face of rare but real phenomena like autoresuscitation that medical science can’t yet explain!
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