[The Lazarus phenomenon. Spontaneous return of circulation after unsuccessful intraoperative resuscitation in a patient with a pacemaker]

We present a case of spontaneous recovery after failed intraoperative cardiopulmonary resuscitation in a patient with a cardiac pacemaker. Of the various mechanisms discussed in the literature, that which seems most relevant in our case of a Lazarus phenomenon, is that of impeded venous return in the course of positive pressure ventilation and hypovolemia.With the disconnection of ventilation, passive cardiac filling combined with electrical stimulation due to the cardiac pacemaker may have caused spontaneous myocardial electrical activity. Corresponding to previous authors,we recommend continued monitoring for 10 min after cessation of cardiopulmonary resuscitation. In addition, we propose a further attempt by disconnecting ventilation and external myocardial stimulation in the case of unresponsiveness to resuscitation efforts.