The Lazarus phenomenon, or Lazarus syndrome, is the return of spontaneous circulation once the heart has stopped and CPR has ceased. There have been 38 reported cases since 1982 when the Lazarus phenomenon was first described in medical reporting. A report published Friday in Medical News Today illuminated a daunting dilemma and a new question for the modern era: Should we delay certifying deaths to make sure that people don’t spontaneously resuscitate?
Reportedly, some researchers believe that the medical staff should passively monitor patients who show no signs of life for 10 minutes after they would normally call a time of death because it is the window of time in which delayed return of spontaneous circulation usually happens. It may seem absurd to delay certifying a death, given how extremely rare Lazarus syndrome is, but as the Medical News Today article pointed out, in a 2016 report, Dr. Vaibhav Sahni said “The Lazarus phenomenon is a grossly underreported event.”
“The reason for these can be attributed to the fact that medicolegal issues are brought to light in cases which are pronounced dead which later turn out to have been alive,” he wrote. “The professional expertise of the resuscitating doctor can be brought into question, not to mention the fact that such an event can lead to disrepute among colleagues.”
Nobody is completely sure what causes someone to spontaneously come back to life after vital signs had ceased. Theories have included the thought that CPR might build up pressure in the chest and once that pressure is gradually released, the heart gets pumped back into action. Some have suggested that maybe its a delayed reaction to medication.
“It is possible that drugs injected through a peripheral vein are inadequately delivered centrally due to impaired venous return, and when venous return improves after stopping the dynamic hyperinflation, delivery of drugs could contribute to return of circulation,” a report published in Journal of the Royal Society of Medicine stated.
Separate from Lazarus syndrome, there are medical conditions that can sometimes make people appear dead when they actually aren’t dead. Hypothermia can cause the heartbeat and respiration to slow to an almost undetectable rate. Catalepsy can last from minutes to weeks, and people with this condition have lowered respiration and become completely immobile. Patients with locked-in syndrome are completely aware of their surroundings but have no control over voluntary muscles.
“Locked-in syndrome is like being buried alive,” Kate Allatt, who had locked-in syndrome, told the Daily Mail. “You can think, you can feel, you can hear, but you can communicate absolutely nothing.”
Allatt heard her doctors and loved ones discussing whether or not to turn off life support. Her condition only lasted two weeks, but she wouldn’t have survived to tell the story if it hadn’t been for life support.
Excited to deliver my 08.30 talk on the importance of language, motivation, social media & codesign on improving patient rehab. #efrr2017 pic.twitter.com/U8zqSYuoGH
— Speaker | Activist (@KateAllatt) May 26, 2017
Allatt’s situation is not the same as Lazarus syndrome, but it brings up many similar questions about the fluidity, or the potential inconclusiveness, of the moments following apparent death. If our deaths are not as clinically concrete as we have believed, how long should medical professionals wait in situations of organ donation?
The Lazarus phenomenon: When the ‘dead’ come back to life https://t.co/noHLOUHSrp pic.twitter.com/Z1OTTqMHYj
— Medical News Today (@mnt) May 27, 2017
If it’s possible that following CPR, a person could experience Lazarus syndrome and come back to life, should doctors wait the extra 10 minutes, even though it could make the organ transplant unsuccessful? The longer blood flow to the organ has been impaired, the less viable the organ will be to the donor recipient. An article in The New England Journal of Medicine gets to the heart of the conundrum.
“When the potential donor meets the criteria for cardiac death, a doctor pronounces the patient dead. The time from the onset of asystole — the absence of sufficient cardiac activity to generate a pulse or blood flow (not necessarily the absence of all electrocardiographic activity) — to the declaration of death is generally about 5 minutes, but it may be as short as 2 minutes.”
What do you think? Should we wait to make sure that people don’t spontaneously resuscitate through a mechanism of Lazarus syndrome after they seem dead, or is it worth the risk if their organs can help someone else?
[Featured Image by vm/iStock]