Do we need standardized management after termination-of-resuscitation attempts? Autoresuscitation in a 67-year-old woman

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Case Report

Paul Imboden¹  Gian-Reto Kleger²  Janina Pasierski³ 

[1] Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;Paramedic Emergency Department, Emergency Physician (SGNOR), St. Gallen, Switzerland;Department of Internal Medicine, Cantonal Hospital St. Gallen, 9007, St. Gallen, Switzerland;Department for Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;Department of Internal Medicine, Cantonal Hospital St. Gallen, 9007, St. Gallen, Switzerland;Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;

关键词: Autoresuscitation;    Lazarus phenomenon;    Cardiopulmonary resuscitation;    Emergency medicine;    Termination of resuscitation;   

DOI  :  10.1186/s13049-023-01137-2

 received in 2023-08-14, accepted in 2023-10-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAutoresuscitation is the phenomenon of spontaneous return of circulation after cessation of CPR, also known as the Lazarus phenomenon. Most of the evidence is based on case reports and a few systematic reviews. The occurrence of autoresuscitation may lead to self-reproach and dismay in affected emergency personnel and may rise questions about the correct procedure after terminating resuscitative efforts. In contrast to existing cardiac arrest guidelines there is no standardized approach to terminating resuscitative attempts.CaseWe report a case of out of hospital autoresuscitation in a 67-year-old female after 60 min of advanced cardiac life support. After shock refractory shockable rhythm, we recorded pulseless electrical activity and fixed pupils, consequently resuscitation was terminated. About 50 min later the patient surprisingly showed signs of life. Due to the suggestive history a coronary angiography was performed, showing severe coronary heart disease which necessitated surgical intervention. After ACBP surgery and intensive care followed by treatment on the cardiological ward, she was finally discharged to neurological rehabilitation.ConclusionAs already proposed by existing literature, there should be at least a 10-min interval of close monitoring after abandoning CPR. Transport of a deceased patient should only take place after secure signs of death can be detected. Further investigation is needed to determine which patients are most likely to benefit from an extended observation period. Our case reports highlights the difficulties in death declaration and the importance of close monitoring after abandoning CPR.

【 授权许可】

CC BY   
© The Author(s) 2023

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