![]() It was therefore decided to review the reported cases of autoresuscitation in patients undergoing CPR, to identify any factors that may contribute to it, and highlight changes in practice that could potentially reduce the likelihood of it occurring. Personnel delivering resuscitation should know about the existence of autoresuscitation before being confronted with it. ![]() The implications of even a few reports of autoresuscitation are significant, not only because it can cause dismay and distress to healthcare professionals, bystanders and family, but also because delayed ROSC could lead to questions being asked about whether resuscitation had been conducted properly and whether it was stopped prematurely. It is believed that the condition is grossly under-reported, partly because of fear of legal repercussions. This means that there may be many unreported cases, since there are ≈1900 Intensive Care consultants in the UK alone. The actual incidence of autoresuscitation is unknown but it is not rare, as surveys have shown that 37–50% of intensive care or prehospital emergency physicians have encountered it in clinical practice. It is sometimes called the “Lazarus Phenomenon” or “Lazarus Syndrome” after Lazarus, who was raised from the dead after 4 days by Jesus. It was first described in 1982 and has been seen in out-of-hospital and in-hospital situations. The following reasons for and recommendations to avoid autoresuscitation can be proposed: 1) In asystole with no reversible causes, resuscitation efforts should be continued for at least 20 min 2) CPR should not be abandoned immediately after unsuccessful defibrillation, as transient asystole can occur after defibrillation 3) Excessive ventilation during CPR may cause hyperinflation and should be avoided 4) In refractory CA, resuscitation should not be terminated in the presence of any potentially-treatable cardiac rhythm 5) After TOR, the casualty should be observed continuously and ECG monitored for at least 10 min.Īutoresuscitation describes the return of spontaneous circulation (ROSC) after termination of resuscitation (TOR) following cardiac arrest (CA), when resuscitation has been attempted but has been deemed unsuccessful and abandoned. ConclusionsĪlmost a third made a full recovery after autoresuscitation. Sixty-five patients with ROSC after TOR were identified in 53 articles (1982–2018), 18 (28%) made a full recovery. 6) Vital signs were sustained for more than a few seconds, such that staff had to resume active care. ![]() No further interventions took place 5) Later, vital signs were observed. We conducted a literature search (Google Scholar, MEDLINE, PubMed) and a scoping review according to PRISMA-ScR guidelines of autoresuscitation cases where patients undergoing CPR recovered circulation spontaneously after TOR with the following criteria: 1) CA from any cause 2) CPR for any length of time 3) A point was reached when it was felt that the patient had died 4) Staff declared the patient dead and stood back. We aimed to identify phenomena that may lead to autoresuscitation and to provide guidance to reduce the likelihood of it occurring. Autoresuscitation describes the return of spontaneous circulation after termination of resuscitation (TOR) following cardiac arrest (CA).
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