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Spontaneous return of circulation after termination of cardiopulmonary resuscitation maneuvers: a systematic review of cases of Lazarus phenomenon

Ballesteros Peña S, Fernández Aedo I, Lorrio Palomino S

Universidad del País Vasco/Euskal Herriko Unibertsitatea, Spain. Hospital Universitario de Basurto. Bizkaia, Spain.

This systematic review includes case reports involving patients in cardiac arrest who
recovered circulation spontaneously in the absence of cardiopulmonary resuscitation
(CPR) or after attempts had been abandoned. We describe the characteristics of these
patients. Following our search protocol we collected case reports of spontaneous
resuscitation from databases of published medical articles; no language limits were set.
Thirty-eight articles describing 49 cases of spontaneous resuscitation were found. Data
on patient characteristics, care characteristics, and clinical course were extracted.
Circulation returned without prior CPR in 3 patients; the others recovered circulation
after CPR had been stopped. Twenty-five (51%) of the patients were male, and the
mean (SD) age was 63.3 (23.1) years (range, 9 months–94 years). Three were pediatric
patients. Time from loss of circulation or termination of CPR attempts until spontaneous
return ranged from “several seconds” to 33 minutes; 33 patients (67.3%) recovered
circulation within 10 minutes. Thirty-one of the patients (63.3%) died while hospitalized;
only 11 (22.4%) were discharged alive without complications or with only slight
neurologic impairment. Although the articles analyzed offer a low level of evidence, they
do suggest that it seems advisable to monitor patients in cardiac arrest for a reasonable
time of 5 to 10 minutes after stopping CPR in order to confirm asystole before certifying

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* Todos los textos disponibles (desde volumen 1, numero 0, 1988)