A case of the ‘Lazarus phenomenon’ after traumatic cardiac arrest

Introduction Auto-resuscitation, also known as the ‘Lazarus phenomenon’, refers to the spontaneous return of circulation following the cessation of cardiopulmonary resuscitation (CPR). The phenomenon is rarely reported, and most involve cases of non-traumatic cardiac arrest, with only four cases having been previously described in trauma patients. Case Report A young male trauma patient presented in extremis following a blunt assault by multiple assailants. Upon arrival to our level I trauma centre, the patient was bradycardic, acidotic, hyperkalaemic, hypoglycaemic and presenting with focal signs of traumatic brain injury. He progressed to pulseless electrical activity, and resuscitative efforts were ceased after being deemed futile. Approximately 5 minutes later, he was then observed to have resumed spontaneous but ineffective respiratory efforts and good cardiac contractility, prompting renewed resuscitation. Despite initial biochemical and haemodynamic improvement, he deteriorated several hours later, and was ultimately pronounced dead for a second time. Discussion With the benefit of a post-mortem examination, the cause of death was likely crush syndrome in the context of mob assault. The precise mechanisms behind auto-resuscitation remain uncertain. Proposed explanations include intrinsic positive end-expiratory pressure (“auto-PEEP”) due to iatrogenic hyperventilation, and a delay in the pharmacological effects of adrenaline. The phenomenon poses a significant communication challenge for clinicians when it comes to informing next of kin of the patient's outcome. Conclusion This case reinforces the importance of continuing to observe patients for at least 10 minutes following termination of CPR in order to identify auto-resuscitation.