The Lazarus Phenomenon - A Remarkable Case of Spontaneous Recovery from Cardiac Arrest in a Do-Not-Resuscitate Patient.

The Lazarus phenomenon, or autoresuscitation, is a rare clinical entity defined as the spontaneous return of circulation in patients following cardiac arrest. Here we report the case of an 88-year-old female who suffered cardiac arrest and received no intervention due to her code status. Despite this, she regained a pulse and consciousness after 167 seconds of pulseless ventricular tachycardia and 108 seconds of asystole consecutively, surviving through pacemaker placement and discharging 5 days later with an intact neurological status. We demonstrate that although rare, favorable outcomes with autoresuscitation are possible, even when no intervention is provided. We also provide a novel explanation for her recovery adding to existing theories on the mechanism of autoresuscitation.

Learning points: Despite its rarity, autoresuscitation may result in favorable neurologic and functional outcomes even when cardiopulmonary resuscitation is not attempted.Patients should be monitored for at least 5 minutes prior to determination of circulatory death.