Lazarus syndrome

Lazarus syndrome is the spontaneous return of circulation after failed attempts at resuscitation.&lt;ref name="ben-david"&gt;&lt;/ref&gt; Its occurrence has been noted in medical literature at least 25 times since 1982.&lt;ref name="delaware-case" /&gt; Also called Lazarus phenomenon, it takes its name from the biblical story of Lazarus, who was raised from the dead by Jesus.&lt;ref name="emj-report"&gt;&lt;/ref&gt;

Occurrences of the syndrome are rare and the causes are not well understood. One theory 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.&lt;ref name="ben-david" /&gt; Other possible factors are hyperkalaemia or high doses of adrenaline.&lt;ref name="emj-report" /&gt;

Cases
One example is a 61-year-old woman from Delaware, USA, who was given "multiple medicines and synchronized shocks", but never regained a pulse. She was declared dead 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.&lt;ref name="delaware-case"&gt; &lt;/ref&gt;

Another case is a 66-year-old man suffering from a suspected abdominal aneurysm. During treatment for this condition, the patient 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.&lt;ref name="ben-david" /&gt;

A 27-year-old man in the UK went into cardiac arrest after overdosing on heroin and ecstasy. 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.&lt;ref name="emj-report" /&gt;

An 18-year-old woman in Missouri, USA, attempted suicide by overdosing on sleeping medication. Resuscitation was attempted, but failed, and she was declared dead. Seven minutes later, her heart started beating and she started breathing on her own again, though she was comatose. The woman regained consciousness 5 days later and was oblivious to what had happened.

A 45 year-old woman in Colombia was pronounced dead, as there were no vital signs showing she was alive. A funeral care worker noticed when she began to move and told his partner that she should go back to hospital. &lt;ref&gt;http://uk.news.yahoo.com/4/20100219/twl-dead-woman-comes-back-to-life-41f21e0.html. Retrieved 19 Feb 2010&lt;/ref&gt;

On June 10, 2009 there was a case in Berchem, Belgium in which a 42 year old male spontaneously revived over an hour after being declared dead.&lt;ref&gt;http://www.deredactie.be/cm/vrtnieuws/ookdatnog/090610_lazarus&lt;/ref&gt;

Implications
The Lazarus Syndrome raises ethical issues for doctors, who must determine when medical death has occurred, resuscitation efforts should end, and post-mortem procedures such as autopsies and organ harvesting may take place.&lt;ref name="ben-david" /&gt; One doctor wrote, "Perhaps it is a supreme hubris on our part to presume that we can reliably distinguish the reversible from the irreversible, or the salvageable from the nonsalvageable."&lt;ref name="ben-david" /&gt;

Medical literature has recommended observation of a patient's vital signs for five to ten minutes after cessation of resuscitation before certifying death.&lt;ref name="emj-report" /&gt;