We have all read this kind of story in the press. Her heart has stopped beating and she is not breathing. This 91-year-old woman has been pronounced dead. She had lived a long life. But she is not ready to stop living it. Eleven hours later, she wakes up in the hospital morgue craving tea and pancakes. As inconceivable as it may seem, this is just one of many stories of people who are said to have “come back from the dead”.
Some cases published in the scientific literature
There have been a number of cases where patients’ vital signs have returned after being pronounced dead.
- In 2001, a 66-year-old man went into cardiac arrest while undergoing surgery for an abdominal aneurysm. After 17 minutes of resuscitation efforts (CPR, defibrillation and medication), the man’s vital signs did not return and he was pronounced dead. Ten minutes later, her surgeon felt a pulse. He was alive. The man’s operation continued, with a positive outcome.
- In 2014, a 78-year-old man was pronounced dead after a hospital nurse found him without a pulse. The next day he woke up in a body bag in the morgue.
These are undoubtedly extraordinary stories that seem more suited to a horror movie, but there is a real-world name for such cases: Lazarus Syndrome.
What is Lazarus Syndrome?
Lazarus phenomenon, or Lazarus syndrome, is defined as a delayed return of spontaneous circulation after cessation of CPR. In other words, patients who are pronounced dead after cardiac arrest experience an impromptu return of cardiac activity.
The syndrome is named after Lazarus of Bethany, who, according to the New Testament of the Bible, was brought back to life by Jesus Christ four days after his death. Lazarus syndrome is the return of spontaneous circulation after cessation of resuscitation.
Since 1982, when the Lazarus phenomenon was first described in the medical literature, at least 38 cases have been reported.
According to a 2007 report, in about 82% of Lazarus syndrome cases to date, ROSC occurred within 10 minutes of stopping CPR, and about 45% of patients experienced good neurological recovery. . But while the low number of reported cases may underscore the rarity of Lazarus syndrome, scientists believe it is far more common than studies suggest.
The reason may have to do with the fact that forensic issues come to light in cases that are pronounced dead who later turn out to have been alive. And obviously the professional expertise of the resuscitator can be called into question, not to mention that such an event can discredit his colleagues. »
Another pertinent question that arises is whether the death of a particular patient occurred as a result of premature termination of resuscitation efforts or the omission of continuous resuscitation. The exact causes of Lazarus phenomenon remain unclear, but there are a few theories.
What could be the cause of Lazarus syndrome?
Some researchers suggest that Lazarus phenomenon could be due to a build up of pressure in the chest caused by CPR. Once resuscitation is stopped, this pressure can gradually release and get the heart back into action.
Another theory is the delayed action of drugs used in resuscitation efforts, such as adrenaline.
Drugs injected through a peripheral vein may not be delivered correctly centrally due to impaired venous return. When venous return improves after dynamic hyperinflation has ceased, drug delivery could contribute to the return of circulation. Hyperkalemia, i.e. too much potassium in the blood, is another proposed explanation for Lazarus phenomenon, as it has been linked to a delay in ROSC.
Since the number of cases of Lazarus syndrome is very low, it is difficult to discover the exact mechanisms of this condition. But perhaps it’s not what brings a patient back to life that we should be concerned about. Perhaps he was never deceased.
Confuse the living with the dead
As Benjamin Franklin once said, “In this world nothing is certain except death and taxes.” In a clinical setting, however, a declaration of death is not as certain as one might think. In 2014, there was a case of an 80-year-old woman who was “frozen alive” in a hospital morgue after being wrongfully pronounced dead.
That same year, a New York hospital came under fire after it wrongly declared a woman brain dead from a drug overdose. The woman woke up shortly after being taken to the operating room for an organ harvest.
Cases like this raise the question: how is it possible to mistakenly declare that a person is dead?
There are two types of death: clinical death and biological death. Clinical death is defined as the absence of pulse, heartbeat, and respiration, while biological death is defined as the absence of brain activity. Reading these definitions, one might think it is easy to know when a person has died. But in some cases it is not so simple.
There are a number of medical conditions that can cause a person to “appear” dead.
Hypothermia, catalepsy and locked-in syndrome
One of these states is hypothermia, in which the body experiences a sudden and life-threatening drop in temperature, normally caused by prolonged exposure to cold. Hypothermia can cause the heart rate and breathing to slow to the point where it is almost undetectable.
Catalepsy
There are a number of conditions in which a patient may “appear” to have died. Catalepsy and locked-in syndrome are examples of other conditions in which the living could be mistaken for the dead.
Catalepsy is characterized by a state of trance, slowed breathing, reduced sensitivity and complete immobility, which can last from a few minutes to several weeks. This condition can be a symptom of neurological disorders such as epilepsy and Parkinson’s disease.
The locked-in syndrome
In locked-in syndrome, a patient is aware of their surroundings, but they experience complete paralysis of voluntary muscles, except for the muscles that control eye movement. In 2014, the Daily Mail reported the case of a 39-year-old Briton, Kate Allatt, with locked-in syndrome.
Unaware of her condition, doctors declared her brain dead. Doctors, family and friends stood by his bedside and discussed whether or not to turn off his life support system. Allatt heard everything, but she couldn’t tell them that she was fully conscious. Lockdown syndrome is like being buried alive. You can think, you can feel, you can hear, but you can’t communicate anything at all.
Confirm death without a doubt
If this article made you shiver, fear not; Lazarus syndrome is extremely rare, as is the possibility of being wrongfully declared dead. That said, the fact that such cases have even occurred has raised questions about the recognition and confirmation of death in a clinical setting.
Some researchers suggest doctors should wait 10 minutes after stopping CPR to see if a patient’s vital signs return. Some researchers have suggested that patients should be “passively watched” for 10 minutes after death.
Because that is the time frame in which a delayed ROSC is most likely to occur. When it comes to organ donation, however, other researchers note that waiting as long as 10 minutes to see if ROSC might occur could be detrimental.
But medical professionals and researchers agree that today’s doctors have the expertise and medical equipment to effectively determine a patient’s death.
Sources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2121643/
https://journals.sagepub.com/doi/full/10.1177/2054270416653523
