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Lazarus syndrome, where a patient is pronounced dead but then suddenly returns to life, is a rare medical phenomenon with various theories about its cause. The legal and physiological implications of mispronouncing someone as dead have led to underreporting, and the phenomenon has raised questions about when a person can be considered dead.
Lazarus syndrome, more formally known as “self-resuscitation after failed cardiopulmonary resuscitation,” is a recognized medical phenomenon in which a patient is pronounced dead after all vital signs must cease only to suddenly return to life. Named after Lazarus, a biblical figure who was brought back to life by Jesus four days after his death, the occurrence of the syndrome is very rare. People who have had Lazarus syndrome include heart patients and patients with obstructive airway disease.
There are a number of theories about how Lazarus Syndrome can occur. Spontaneous resuscitation may be due to the delayed effects of drugs being administered to the patient. For example, in heart patients, there may be a delay in the effects of adrenaline administration. In hyperkalemic patients, the effects of bicarbonate may take longer than expected to work. When these drugs finally kick in, however, circulation is restored on its own.
There may also be an accumulation of intravascular plaque, which after CPR is administered is removed after a delayed period of time. Although delayed, this action later allows the heart to restart. Finally, in patients with obstructive airway disease, hyperventilation and the inability to exhale properly create a significant amount of pressure in the chest. Once the vital signs have ceased and the patient stops breathing, there may be some relief from this hyperinflation and the resultant pressure, allowing normal bodily function to begin.
The onset of Lazarus syndrome can be more common than it seems. There may be a lack of reporting of the phenomenon due to the legal and physiological implications it can have. The hospital and physician, for example, may be held legally liable for mispronouncing the individual as dead and halting life-saving measures that can preserve mental and physical function. The competence of the personnel involved could be questioned and the simple lack of physiological explanations in some cases can create discomfort and disbelief.
Lazarus syndrome has raised a number of questions in the medical community about the certainty of death and what this might mean for some procedures. For example, situations such as heart-stopping organ donation, when a person on life support is disconnected immediately prior to donation, have raised questions about when a person can be considered dead. Other questions have been raised regarding when resuscitation efforts should have ceased and how long after a person is pronounced dead an autopsy should be performed. For many people, this phenomenon is reminiscent of the Victorian practice of burying a loved one with a rope in hand attached to a bell above ground, just in case.
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