Making its maiden appearance in medical journals in 1982, the coinage of the term has its origins in the Christian gospel account of Lazarus of Bethany, who was miraculously brought back to life by Jesus Christ four days after his death. The Lazarus phenomenon is described as “delayed return of spontaneous circulation (ROSC) after cessation of cardiopulmonary resuscitation (CPR).” 1 Such patients, who appear clinically dead, return from the brink of death long after a failed CPR, doing so spontaneously and unassisted. I had just witnessed my first case of the Lazarus phenomenon. The patient in question was wheeled to the ICU, where active care resumed and she recuperated before she “truly” died of a massive pulmonary thromboembolism five days later. This is a true account of a personal experience I had as an emergency department doctor during a night shift at a busy hospital. The flat line morphs into a sinus rhythm before our eyes, and the “dead” body’s chest begins to heave with spontaneous respiratory effort. Next, the cardiac monitor beeps with a heart rate. Twelve minutes after the declaration of time of death, the endotracheal tube sticking out of the deceased woman’s mouth starts visibly moving. The dejected code-blue team reluctantly disperses to their stations, as a nurse and I remain behind to do the requisite documentation. The morgue attendant, as a matter of course, is called. “Time of death, 2:06 AM,” announces the lead doctor. The relentless cardiac monitor screams its flat-line signal as the code-blue team pants, scrubs clinging to their sweaty chests after a phenomenal forty-five-minute cardiopulmonary resuscitation (CPR) attempt. A middle-aged woman lays motionless on a table in a hospital emergency department with tubes protruding from multiple orifices. (A) Normal posture of the brain-dead patient (B) posture when the Lazarus sign occurs: bilateral arm flexion to the chest, shoulder adduction, and hand crossing for about 10 to 30 seconds before returning to the normal posture.It is a few minutes after 2 AM. FIGURE 1 In the brain computed tomography performed on the day of admission, subarachnoid hemorrhage in both cerebral hemispheres and a large intracerebral hemorrhage in the left sylvian cistern area with intraventricular hemorrhage were found.įIGURE 2 In the follow-up brain computed tomography performed on postoperative day 40, large cerebral herniation through the craniectomy site and decreased corticomedullary differentiation of the cerebral hemisphere were observed.įIGURE 3 In the follow-up brain computed tomography performed on postoperative day 65, decreased cerebral herniation through the craniectomy site and no change of decreased corticomedullary differentiation of the cerebral hemisphere were observed.įIGURE 4 In the follow-up brain computed tomography performed on postoperative day 142, resolving intraventricular hemorrhage in left frontal area and diffuse brain swelling with severe midline shift and increased pneumocephalus in left frontal lobe were observed.įIGURE 5 No notable findings were observed in the brain computed tomography performed on the day of admission.įIGURE 6 In the follow-up brain computed tomography performed on day 9 post-admission, diffuse severe brain swelling with transtentorial herniation was found.įIGURE 7 The Lazarus sign.
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