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Lazarus-Phänomen

Spontane Kreislauffunktion nach beendeten Reanimationsmaßnahmen

Lazarus phenomenon

Spontaneous return of circulation after cardiac arrest and cessation of resuscitation attempts

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Zusammenfassung

Hintergrund

Als „Lazarus-Phänomen“ wird in der medizinischen Wissenschaft das „Auftreten einer spontanen Kreislauffunktion im zeitlichen Intervall nach Beendigung von Reanimationsmaßnahmen“ bezeichnet. Ziel der im Folgenden beschriebenen Studie war es, Berichte der medizinischen Fachliteratur bezüglich der Gemeinsamkeiten und Unterschiede bei stattgehabtem Lazarus-Phänomen zu analysieren.

Methode

Es wurde eine Literaturrecherche der Jahre 1982 bis 2009 bei Medline, PubMed, Embase, Google Scholar und Google mit den Suchbegriffen „Lazarus phenomenon“, „cessation of cardiopulmonary resuscitation and return of spontaneous circulation (ROSC)“, „spontaneous return of circulation (SROC)“, „resuscitation and spontaneous defibrillation“, „spontaneous recovery and cardiopulmonary resuscitation“ durchgeführt.

Ergebnisse

Insgesamt konnten mehr als 10.000 Einträge und Artikel, die die definierten Suchwörter enthielten, identifiziert werden. Als medizinisch relevante Fachbeiträge (Kommentare, Abstracts, Einzelfallberichte, Fallsammlungen und Übersichtsarbeiten) wurden 45 Einträge identifiziert und untersucht.

Diskussion

Das Lazarus-Phänomen ist in der medizinischen Fachliteratur eher selten beschrieben. Trotzdem tritt es (auch bei Berücksichtigung berichteter, aber medizinisch nichtpublizierter Fälle) häufiger auf als angenommen. Wissenschaftliche Erklärungen bezüglich der Ursachen können praktisch nicht evidenzbasiert begründet werden („auto positive end-expiratory pressure“, Hyperventilation mit reaktiver Alkalose, Intubationsreiz, Hyperkaliämie, verzögerte Medikamentenwirkung, nichtbeobachtete „vita minima“). Zur Vermeidung eines Lazarus-Phänomens wird allgemein empfohlen, die Asystolie nach Beendigung der Reanimationsmaßnahmen für mindestens weitere 10 min elektrokardiographisch zu dokumentieren. Wissenschaftliche experimentelle Arbeiten erscheinen notwendig, um den Pathomechanismus dieses Phänomens besser zu verstehen.

Abstract

Background

In the medical literature the Lazarus phenomenon is defined as the spontaneous return of circulation (SROC) after cessation of cardio-pulmonary resuscitation. Based on published literature recommendations concerning the treatment of patients after cessation of resuscitation and reasons for the Lazarus phenomenon are discussed.

Methods

A literature search in Medline, PubMed, Embase, Google Scholar and Google from 1982 to 2009 was carried out for the terms “Lazarus phenomenon”, “cessation of cardiopulmonary resuscitation and return of spontaneous circulation (ROSC)”, “spontaneous return of circulation (SROC)”, “resuscitation and spontaneous defibrillation”, “spontaneous recovery and cardiopulmonary resuscitation”. Related secondary literature which was cited in the relevant articles was included as well as publications found in our personal literature base.

Results

More than 10,000 articles and comments could be recovered and of these 45 were considered to be medically relevant articles (letters to the Editor, abstracts, case reports and literature reviews).

Conclusions

In the relevant medical literature, the Lazarus phenomenon is a rare occurrence. It seems to be a phenomenon which has often been described in non-medical literature but not published in medical literature. The pathophysiological mechanisms are poorly understood. In the literature several mechanisms are discussed which could be important for this phenomenon, e.g. autopositive end-expiratory pressure, hyperventilation and alkalosis, hyperkalemia, delayed action of drugs and unobserved minimal vital signs. In the literature it is recommended that patients should be passively monitored for at least 10 min after cessation of resuscitation. However, more scientific experimental investigations seem to be necessary to gain a better understanding of this phenomenon.

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Danksagung

Der besondere Dank der Autoren gilt Herrn Prof. Dr. jur. G. Duttge (Geschäftsführender Direktor des Zentrums für Medizin- und Biorecht, Georg-August-Universität, Göttingen) für die rechtliche Bewertung des Lazarus-Phänomens.

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  1. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    C.H.R. Wiese, S. Orso & B.M. Graf

  2. Abteilung Kardioanästhesie, Universitätsklinikum Ulm, Ulm, Deutschland

    U.E. Bartels

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  1. C.H.R. Wiese
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  2. U.E. Bartels
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  3. S. Orso
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Correspondence to C.H.R. Wiese.

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C.H.R. Wiese, U.E. Bartels und S. Orso waren an der Erarbeitung und Durchführung des Studiendesigns und der Studie sowie an der Manuskripterstellung und der Manuskriptkorrektur beteiligt. C.H.R. Wiese wertete maßgeblich die Daten der Fallberichte aus. S. Orso und B.M. Graf waren an der Mitbearbeitung und Editierung des Manuskripts sowie wichtigen Korrekturen maßgeblich beteiligt. Alle Autoren haben die Endversion des Manuskripts gelesen und sind mit der Publikation einverstanden.

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Wiese, C., Bartels, U., Orso, S. et al. Lazarus-Phänomen. Anaesthesist 59, 333–341 (2010). https://doi.org/10.1007/s00101-010-1709-7

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