Spontaneous return of circulation after termination of cardiopulmonary resuscitation maneuvers: a systematic review of cases of Lazarus phenomenon

Ballesteros Peña S, Fernández Aedo I, Lorrio Palomino S

This systematic review includes case reports involving patients in cardiac arrest who

recovered circulation spontaneously in the absence of cardiopulmonary resuscitation

(CPR) or after attempts had been abandoned. We describe the characteristics of these

patients. Following our search protocol we collected case reports of spontaneous

resuscitation from databases of published medical articles; no language limits were set.

Thirty-eight articles describing 49 cases of spontaneous resuscitation were found. Data

on patient characteristics, care characteristics, and clinical course were extracted.

Circulation returned without prior CPR in 3 patients; the others recovered circulation

after CPR had been stopped. Twenty-five (51%) of the patients were male, and the

mean (SD) age was 63.3 (23.1) years (range, 9 months–94 years). Three were pediatric

patients. Time from loss of circulation or termination of CPR attempts until spontaneous

return ranged from “several seconds” to 33 minutes; 33 patients (67.3%) recovered

circulation within 10 minutes. Thirty-one of the patients (63.3%) died while hospitalized;

only 11 (22.4%) were discharged alive without complications or with only slight

neurologic impairment. Although the articles analyzed offer a low level of evidence, they

do suggest that it seems advisable to monitor patients in cardiac arrest for a reasonable

time of 5 to 10 minutes after stopping CPR in order to confirm asystole before certifying

death.

Ballesteros Peña S, Fernández Aedo I, Lorrio Palomino S