Skip to main content
SpringerLink
Log in

Lazarus-Phänomen

Aktueller Stand der Reanimation und Fragen an den medizinischen Gutachter

Lazarus phenomenon

Current resuscitation standards and questions for the expert witness

  • Originalien
  • Published:
Rechtsmedizin Aims and scope Submit manuscript

Zusammenfassung

Bis dato sind umfangreiche Richtlinien bezüglich Art und Umfang von Reanimationsmaßnahmen publiziert worden. Wann eine Reanimation im Einzelfall abzubrechen ist, ist nach wie vor Gegenstand einer interdisziplinär geführten Diskussion. Die Entscheidung zum Reanimationsabbruch setzt eine Abwägung zahlreicher Faktoren voraus und muss letztlich im Einzelfall getroffen werden. Vor diesem Hintergrund stellen die Autoren aus der Sicht des medizinischen Gutachters einen Fall vor, bei dem nach Beendigung der Reanimation nach einer beträchtlichen zeitlichen Latenz beim Patienten erneut Lebenszeichen sowie elektrokardiographisch regelmäßige Herzaktionen zu beobachten waren. Der gegenständliche Fall zeigt, dass sowohl Ablauf und Umfang der Reanimation als auch die Todesfeststellung nach erfolgloser Reanimation nach wie vor für den betreffenden Arzt eine große Herausforderung darstellen, und dass präzise Richtlinien, auch den Abbruch der Reanimation betreffend, notwendig sind.

Abstract

To date exhaustive guidelines in relation to details of cardiopulmonary resuscitation (CPR) have been published but the interdisciplinary discussion as to the individual duration and termination of resuscitation efforts continues. The decision to terminate CPR efforts is dependent on an analysis of the numerous specific factors of each individual case. In this light, we present a case from the point of view of the expert witness, in which CPR had been terminated but renewed life signs and regular cardiac action in the ECG were observed considerably later. The case at hand illustrates that details of resuscitation as well as determination of death after unsuccessful CPR still represent a challenge for the individual physician. It follows that precise guidelines, among others in respect to the termination of CPR are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. American Heart Association in Collaboration with the International Liaison Committee on Resuscitation (2000) Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Resuscitation 46: 1–448

    Article  PubMed  Google Scholar 

  2. Aprahamian C, Thompson BM, Gruchow HW, Mateer JR, Tucker JF, Stueven HA, Darin JC (1986) Decision making in prehospital sudden cardiac arrest. Ann Emerg Med 15: 445–449

    Article  Google Scholar 

  3. Bailey ED, Wydro GC, Cone DC (2000) Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care 4(2): 190–195

    PubMed  Google Scholar 

  4. Baskett P, Fisher J, Marsden A (1996) Recognition of death by ambulance personnel. Joint Royal Colleges Ambulance Liaison Committee: Newsletter 1

    Google Scholar 

  5. Becker LB, Ostrander MP, Barrett J, Kondos GT (1991) Outcome of CPR in a large metropolitan area – where are the survivors? Ann Emerg Med 20: 355–361

    Article  PubMed  Google Scholar 

  6. Bonnin MJ, Pepe PE, Kimball K, Clark PS Jr (1993) Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA 270: 1457–1462

    Article  PubMed  Google Scholar 

  7. Bradbury N (1999) Lazarus phenomenon: another case? Resuscitation 41: 87

    Article  PubMed  Google Scholar 

  8. Cooper S, Cade J (1997) Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. Resuscitation 35: 17–22

    Article  PubMed  Google Scholar 

  9. Dück MH, Paul M, Kämmerer H (2003) Das Lazarus-Phänomen. Spontane Kreislaufstabilisierung nach erfolgloser intraoperativer Reanimation bei einem Patienten mit Herzschrittmacher. Anaesthesist 52: 413–418

    Article  PubMed  Google Scholar 

  10. Engdahl J, Bang A, Lindqvist J, Herlitz J (2000) Can we define patients with no and those with some chance of survival when found in asystole out of hospital? Am J Cardiol 86: 610–614

    Article  PubMed  Google Scholar 

  11. Eisenberg MS, Mengert TJ (2001) Cardiac resuscitation. N Engl J Med 344: 1304–1313

    Article  PubMed  Google Scholar 

  12. Frandsen F, Nielsen JR, Gram L, Larsen CF, Jorgensen HR, Hole P, Haghfelt T (1991) Evaluation of intesified prehospital treatment in out-of-hospital cardiac arrest: survival and cerebral prognosis. The Odense ambulance study. Cardiology 79: 256–264

    PubMed  Google Scholar 

  13. Heller AR, Müller MP, Frank MD, Dreßler J (2005) Rigor mortis – Ein sicheres Todeszeichen? Anaesthesiol Intensivmed Notfall Schmerzther 40: 225–229

    Article  Google Scholar 

  14. Herlitz J, Engdahl J, Svensson L, Young M, Ängquist K-A, Holmberg S (2004) Can we define patients with no chance of survival after out-of-hospital cardiac arrest? Heart 90: 1114–1118

    Article  PubMed  Google Scholar 

  15. Linko K, Honkavaara P, Salmenpera M (1982) Recovery after discontinued cardiopulmonary resuscitation. Lancet 1: 106–107

    Article  Google Scholar 

  16. Litwin PE, Eisenberg MS, Hallstrom AP, Cummins RO (1987) The location of collapse and its effect on survival from cardiac arrest. Ann Emerg Med 16: 787–791

    Article  PubMed  Google Scholar 

  17. Lockey AS (2002) Recognition of death and termination of cardiac resuscitation attempts by UK ambulance personnel. Emerg Med J 19: 345–347

    Article  PubMed  Google Scholar 

  18. MacGillivray RG (1999) Spontaneous recovery after discontinuation of cardiopulmonary resuscitation. Anesthesiology 91: 585–586

    Article  PubMed  Google Scholar 

  19. Madea B (Hrsg) (1999) Die ärztliche Leichenschau – Rechtsgrundlagen – Praktische Durchführung – Problemlösungen. Springer, Berlin Heidelberg New York Tokyo

  20. Maeda H, Fujita MQ, Zhu BL, Yukioka H, Shindo M, Quan L, Ishida K (2002) Death following spontaneous recovery from cardiopulmonary arrest in a hospital mortuary: „Lazarus phenomenon“ in a case of alleged medical negligence. Forensic Sci Int 127: 82–87

    Article  PubMed  Google Scholar 

  21. Maleck WH, Piper SN, Triem J, Boldt J, Zittel FU (1998) Unexpected return of spontaneous circulation after cessation of resuscitation (Lazarus phenomenon). Resuscitation 39: 125–128

    Article  PubMed  Google Scholar 

  22. Petrie DA (2002) Termination-of-resuscitation guidelines in a basic life support-defibrillation system. Acad Emerg Med 9: 1460–1461

    Article  PubMed  Google Scholar 

  23. Prokop O, Göhler W (1976) Sterben und Todeszeichen. In: Prokop O, Göhler W (Hrsg) Forensische Medizin. Fischer, Stuttgart, S 11–31

  24. Püschel K, Lach H, Wirtz S, Moecke H (2005) Ein weiterer Fall von „Lazarus-Phänomen“? Notfall Rettungsmed 8: 528–532

    Article  Google Scholar 

  25. Salvia A de, Guardo A, Orrico M, Leo D de (2004) A new case of Lazarus phenomenon? Forensic Sci Int 146 [Suppl]: 13–15

  26. Schneider V (1987) Die Leichenschau. Fischer, Stuttgart

  27. Schultz SC, Cullinane DC, Pasquale MD, Magnant C, Evans SR (1996) Predicting in-hospital mortality during cardiopulmonary resuscitation. Resuscitation 33: 13–17

    Article  PubMed  Google Scholar 

  28. Smith JP, Bodai BI (1985) Guidelines for discontinuing prehospital CPR in the emergency department – A review. Ann Emerg Med 14: 1093–1098

    Article  PubMed  Google Scholar 

  29. Spaulding C, Rozenberg A, Laurent I (2000) Cardiac arrest outside the hospital. Rev Prat 50: 36–39

    PubMed  Google Scholar 

  30. Stratton SJ, Niemann JT (1998) Outcome from out-of-hospital cardiac arrest caused by nonventricular arrhythmias: contribution of successful resuscitation to overall survivorship supports the current practice of initiating out-of-hospital ACLS. Ann Emerg Med 32: 448–453

    Article  PubMed  Google Scholar 

  31. Vos R de, Oosterom L, Koster RW, Haan RJ de (1998) Decisions to terminate resuscitation. Resuscitation 39: 7–13

    Article  PubMed  Google Scholar 

  32. Wuerz RC, Holliman CJ, Meador SA, Swope GE, Balogh R (1995) Effect of age on prehospital cardiac resuscitation outcome. Am J Emerg Med 13: 389–391

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Interfakultärer Fachbereich für Gerichtsmedizin und Forensische Neuropsychiatrie, Paris-Lodron-Universität, Salzburg, Österreich

    H. J. Meyer

  2. Unfallkrankenhaus, Linz, Österreich

    N. Bauer

  3. Interfakultärer Fachbereich für Gerichtsmedizin und Forensische Neuropsychiatrie, Paris-Lodron-Universität, Ignaz-Harrer-Strasse 79, 5020, Salzburg, Österreich

    F. Monticelli

Authors
  1. F. Monticelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. J. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Monticelli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Monticelli, F., Bauer, N. & Meyer, H.J. Lazarus-Phänomen. Rechtsmedizin 16, 57–63 (2006). https://doi.org/10.1007/s00194-006-0366-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00194-006-0366-2

Schlüsselwörter

Keywords

Search

Navigation