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Lazarus phenomenon in an out-of-hospital emergency attended by a home emergency service

Rodríguez Aguado O, Suárez Portilla FJ, Novalbos Ruiz JP, De La Fuente Rodríguez JM, Rodríguez Fernández MR

Empresa P√ļblica de Emergencias Sanitarias (EPES). Servicio Provincial de C√°diz. Universidad de C√°diz. √Ārea de Medicina Preventiva y Salud P√ļblica. Servicio M√©dico Correos S.E. Jefatura Provincial de C√°diz. C√°diz, Spain.

Lazarus phenomenon, or spontaneous recovery following cardiopulmonary resuscitation
(CPR), is a rare event. We report a possible case attended by our home emergency team
in Cadiz, Spain. The family of a patient with chronic obstructive pulmonary disease asked
for emergency care for breathlessness. On arrival, we found the patient unconscious and
in respiratory arrest but a central pulse could be detected; pupils were fixed, partially
dilated, and unresponsive. We immediately commenced advanced life-support
measures. Respiratory function deteriorated (severe bronchospasm); there followed a
worsening of hemodynamics and cardiac arrest. After 30 minutes of advanced CPR,
efforts ceased with the patient in asystole and apneic. Ten minutes later, pulse recovered
spontaneously. The patient was reintubated and transferred to the hospital, where he
died 12 days later. Although Lazarus phenomenon is unpredictable and rare, 2
conclusions can be drawn about this event in an out-of-hospital setting: a longer delay in
providing emergency care favors the persistence of asystole, and respiratory volumes
administered must be monitored strictly to avoid the risk of dynamic hyperinflation.

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