Sir
Few cases of Lazarus phenomenon – also called auto-resuscitation and defined as delayed return of circulation (ROSC) after termination of cardiopulmonary resuscitation (CPR) – have been published in last decades [
[1]
]. Nevertheless, mechanism and frequency of this phenomenon are not stated clearly. The Lazarus phenomenon is considered to be rare but some authors suggested that cases are under-reported due to fear of medico-legal consequences and disrepute among the physicians [[2]
]. As a matter of fact, auto-resuscitation could put physician in an embarrassing situation, especially when family members or relatives have been previously informed of the patient's death. In order to prevent this situation, most authors recommend monitoring patients for at least 10 min after discontinuation of CPR [[3]
]. Physicians should know the existence of this phenomenon before being confronted with it.In France, around forty thousand out-of-hospital cardiac arrests occur each year [
[4]
]. Those patients are cared for by mobile intensive care units, which always include an emergency physician. To assess knowledge, attitude and practice related to the Lazarus phenomenon, a national survey based on a randomized sample of French prehospital emergency physicians was performed in March 2013.Recommandations formalisées d’experts sur la prise en charge de l’arrêt cardiaque. Société Française d’Anesthésie et de Réanimation et Société de Réanimation de Langue Française. <http://www.sfar.org/_docs/articles/91-ac_rfe07.pdf>; 2006 [accessed 01.07.2013].
All of them (n = 103) answered our survey (response rate = 100%). Although the majority of them (69%) knows that auto-resuscitation exists, almost no physicians knows the naming “Lazarus phenomenon” which is commonly used in the dedicated literature. These physicians reported that they discovered the existence of auto-resuscitation by facing it (54%), by sharing colleague's experience (31%), or from postgraduate and continuing medical education (only 4%). In all, 45% of physicians indicated that they had already been confronted with auto-resuscitation. Most of them reported surprise (88%) or embarrassment (71%). In contrast, concerns about legal claim or disrepute among physicians were infrequent in our study (37% and 23%, respectively). Although it has been reported in literature [
[5]
], many physicians (63%) believed that auto-resuscitation cannot lead to survival without neurologic disability. Furthermore, 66% reported withholding of life support despite ROSC. Finally, only a third of physicians (35%) affirmed that they regularly monitor patients following unsuccessful CPR.This study suggests that the Lazarus phenomenon is frequent enough to be encountered by almost half of French prehospital emergency physicians. Unfortunately, most of them discover this phenomenon during the treatment of a patient. On the whole, physicians seem to have a limited and empirical knowledge of auto-resuscitation, which could lead to embarrassment and inappropriate decisions, withholding of life support in particular. We would like to draw attention to the need for greater emphasis on the Lazarus phenomenon during the medical education. We also encourage the physicians to monitor patients more often when CPR is discontinued to better identify auto-resuscitation.
Conflict of interest statement
The authors have no conflict of interest to declare.
References
- The Lazarus phenomenon.J R Soc Med. 2007; 100: 552-557
- The Lazarus phenomenon-false positive death certifications and auto-resuscitation cases covered in lay press.Resuscitation. 2011; 82: 1363-1364
- Recovery after discontinued cardiopulmonary resuscitation.Lancet. 1982; 1: 106-107
Recommandations formalisées d’experts sur la prise en charge de l’arrêt cardiaque. Société Française d’Anesthésie et de Réanimation et Société de Réanimation de Langue Française. <http://www.sfar.org/_docs/articles/91-ac_rfe07.pdf>; 2006 [accessed 01.07.2013].
- A systematic review of autoresuscitation after cardiac arrest.Crit Care Med. 2010; 38: 1246-1253
Article info
Publication history
Published online: August 16, 2013
Received:
July 29,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
