Delayed return of spontaneous circulation (the Lazarus phenomenon) after cessation of out-of-hospital cardiopulmonary resuscitation

RESUSCITATION

卷:118

Article

Kuisma, Markku¹  Salo, Ari¹  Puolakka, Jyrki¹  Nurmi, Jouni¹  Kirves, Hetti³  Vayrynen, Taneli²  Boyd, James¹ 

[1] Helsinki Univ Hosp, Dept Emergency Med, Sect Emergency Med Serv, Helsinki, Finland

[2] Vaasa Cent Hosp, Emergency Med Serv, Vaasa, Finland

[3] Hosp Dist Helsinki & Uusimaa, Emergency Med Serv, Hyvinkaa, Finland

关键词: Cardiopulmonary resuscitation;    Death;    Lazarus phenomenon;   

DOI  :  10.1016/j.resuscitation.2017.07.022

来源: Elsevier

【 摘 要 】

Introduction: The delayed return of spontaneous circulation (ROSC) after cessation of cardiopulmonary resuscitation (CPR), also known as the Lazarus phenomenon, is a rare event described in several case reports. This study aims to determine the incidence and the time of occurrence of the Lazarus phenomenon after cessation of out-of-hospital CPR. Methods: This prospective observational cohort study was conducted in the Helsinki Emergency Medical Service in Finland from 1 January 2011 through 31 December 2016. All out-of-hospital CPR attempts were carefully monitored for 10 min after the cessation of CPR in order to detect delayed ROSC. Results: Altogether, 2102 out-of-hospital cardiac arrests occurred during the six-year study period. CPR was attempted in 1376 (65.5%) cases. In 840 cases (61.0% of all attempts) CPR attempts were terminated on site. The Lazarus phenomenon occurred five times, with an incidence of 5.95/1000 (95% CI 2.10-14.30) in field-terminated CPR attempts. Time to delayed ROSC from the cessation of CPR varied from 3 to 8 min. Three of the five patients with delayed ROSC died at the scene within 2-15 min while two died later in hospital within 1.5 and 26 h, respectively. Conclusions: We observed that the Lazarus phenomenon is a real albeit rare event and can occur a few minutes after the cessation of out-of-hospital CPR. We suggest a 10-min monitoring period before diagnosing death. CPR guidelines should be updated to include information of the Lazarus phenomenon and appropriate monitoring for it. (C) 2017 Elsevier B.V. All rights reserved.

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