The Lazarus Phenomenon: Auto- Cardioversion After Termination of Resuscitation -A Case Report

Introduction: Lazarus phenomenon is rare, and a dramatic occurrence characterised by a delayed return of spontaneous circulation after cardiopulmonary resuscitation is terminated. We report a case of this rare phenomenon. Case Presentation: A 45-year-old unemployed man with haemorrhagic pericardial effusion developed iatrogenic perforation of the right ventricle and cardiac tamponade during attempted catheter pericardiocentesis. He became hemodynamically unstable for which he was referred to the cardiothoracic centre and an emergency sternotomy was carried out. He arrested as he was being wheeled to theatre. The sternum was opened, the perforations were repaired, direct cardiac massage was carried out, he was defibrillated 14 times each with 20 joules but there was no response. He was declared dead after 40 minutes of resuscitation. After an additional 20 minutes of no cardiac activity while he was being closed, he regained spontaneous cardiac activity and eventually recovered. Three years of follow up did not reveal any neurological sequelae. Conclusion: Though the Lazarus phenomenon is rare, it is observable and therefore clinicians should be aware of this phenomenon, and to observe any patient for at least 10-15 minutes (watchful waiting period) using non-invasive monitoring after the termination of cardiopulmonary resuscitation before confirming death.