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• W2075943670 abstract "Autoresuscitation, defined as the unassisted return of spontaneous circulation after cardiac arrest, has been described in various case reports and subsequently termed the “Lazarus phenomenon.”1Bray Jr., J.G. The Lazarus phenomenon revisited.Anesthesiology. 1993; 78: 991Crossref PubMed Scopus (40) Google Scholar Systemic reviews have compiled over 30 adult cases, yet failed to discover any cases in children.2Hornby K. Hornby L. Shemie S.D. A systemic review of autoresuscitation after cardiac arrest.Crit Care Med. 2010; 38: 1246-1253Crossref PubMed Scopus (126) Google Scholar We recently had a case of autoresuscitation in a 10-year-old child. The patient was a 10-year-old female with history of mental retardation and cerebral palsy, including microcephaly, spastic quadriplegia and central and obstructive apnoea, requiring a tracheostomy with a home ventilator. The patient had recently started on levofloxacin for possible bacterial pneumonia. On the day of admission, her mother was awakened at 3:30 a.m. by the patient's respiratory alarm and found her pale and unresponsive. On arrival of emergency services, asystole was confirmed. Resuscitation was begun with cardiac compressions, adrenaline and atropine with change to pulseless electrical activity (PEA). She was transported to the emergency department where an additional five doses of adrenaline, three doses of atropine and one dose each of calcium and sodium bicarbonate were administered. Subsequent ventricular tachycardia and then ventricular fibrillation were treated with defibrillation with return to PEA. After 40 min of therapy, further resuscitation was stopped and death declared at 4:17 a.m. At 4:19 a.m., the bedside nurse was removing the patient's monitor leads when she noted a palpable pulse. A blood pressure reading of 79/46 mmHg was obtained. Additional adrenaline followed by an infusion was administered, with increase in heart rate from 85 to 110 bpm and a blood pressure of 114/63 mmHg. She was transferred to the paediatric intensive care unit (PICU). In the PICU, neurologic exam revealed fixed, dilated pupils and the absence of brain stem reflexes. After discussion with the patient's mother, the decision was made to withdraw care. The incidence of autoresuscitation phenomena in both adults and children is unknown. Autoresuscitation cases are likely underreported, and this is the first reported case in a child we are aware of. While the explanation for autoresuscitation is poorly understood, auto-PEEP and hyperinflation occurring during the resuscitation efforts may play a role.3Lapinsky S.E. Leung R.S. Auto-PEEP and electromechanical dissociation.N Engl J Med. 1996; 335: 674Crossref PubMed Scopus (47) Google Scholar In our paediatric patient, we note two similarities with previous adult reports: (1) return of spontaneous circulation occurred within 7 min of failed resuscitation (2 min in our case); and (2) cardiopulmonary resuscitation was provided and discontinued prior to autoresuscitation.2Hornby K. Hornby L. Shemie S.D. A systemic review of autoresuscitation after cardiac arrest.Crit Care Med. 2010; 38: 1246-1253Crossref PubMed Scopus (126) Google Scholar With the acceptance of donation after cardiac death (DCD) for organ transplantation, the length of time prior to declaration of death after cardiac arrest remains important to conform to the “dead donor rule.”4Truog R.D. Miller F.G. The dead donor rule and organ transplantation.N Eng J Med. 2008; 359: 674-675Crossref PubMed Scopus (145) Google Scholar As the clinical interval becomes progressively shortened, as little as 75 s in two recent cases using a paediatric cardiac transplantation DCD protocol,5Boucek M.M. Mashburn C. Dunn S.M. et al.Pediatric heart transplantation after declaration of cardiocirculatory death.N Engl J Med. 2008; 359: 709-714Crossref PubMed Scopus (317) Google Scholar the window to detect autoresuscitation is reduced. While we are reassured there are no reports of autoresuscitation without cardiopulmonary resuscitation, caregivers of both adults and children should be aware of its possibility before the declaration of death. The authors have no conflicts of interest to report." @default.
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• W2075943670 title "Autoresuscitation in a child: The young Lazarus" @default.
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• W2075943670 doi "https://doi.org/10.1016/j.resuscitation.2010.09.015" @default.
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