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      Risen Alive: The Lazarus Phenomenon

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      Case Reports in Critical Care
      Hindawi

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          Abstract

          The Lazarus phenomenon described as delayed return of spontaneous circulation (ROSC) after cessation of CPR is rare, though underreported. We present the case of a 25-year-old woman who visited our hospital for persistent vomiting and weight loss for the last six months following bariatric surgery. On the 16 th day of admission, the patient experienced cardiac arrest (code blue). The patient underwent 73 min of continuous cardiopulmonary resuscitation (CPR); however, no responses were observed, which led to an announcement of death. Fifty minutes later, the family members noticed subtle eye movements that necessitated resumption of the advanced cardiac life support protocol and resuscitation. The patient survived; however, she developed significant neurological deficits secondary to prolonged anoxic brain injury. She was discharged after a ten-week stay in the hospital but did not achieve full neurologic, cognitive, and motor recovery. Patients should be observed and monitored after the cessation of CPR before confirming death.

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          Most cited references25

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          International guideline development for the determination of death

          Introduction and Methods This report summarizes the results of the first phase in the development of international guidelines for death determination, focusing on the biology of death and the dying process, developed by an invitational forum of international content experts and representatives of a number of professional societies. Results and Conclusions Precise terminology was developed in order to improve clarity in death discussion and debate. Critical events in the physiological sequences leading to cessation of neurological and/or circulatory function were constructed. It was agreed that death determination is primarily clinical and recommendations for preconditions, confounding factors, minimum clinical standards and additional testing were made. A single operational definition of human death was developed: ‘the permanent loss of capacity for consciousness and all brainstem functions, as a consequence of permanent cessation of circulation or catastrophic brain injury’. In order to complete the project, in the next phase, a broader group of international stakeholders will develop clinical practice guidelines, based on comprehensive reviews and grading of the existing evidence.
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            Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the auto-PEEP effect.

            Alveolar pressure can remain positive throughout the ventilatory cycle of mechanically-ventilated patients with airflow obstruction, even when positive end-expiratory pressure (PEEP) is not applied intentionally. The increase of intrathoracic pressure associated with this "auto-PEEP" phenomenon can severely depress cardiac output as well as elevate the end-expiratory pulmonary artery wedge pressure. Such effects may be exaggerated in patients with chronic obstructive pulmonary disease because abnormally compliant lungs transmit a high fraction of alveolar pressure to intrathoracic vessels. Failure to recognize the hemodynamic consequences of auto-PEEP may lead to inappropriate fluid restriction or unnecessary vasopressor therapy. Although not apparent during normal ventilator operation, the auto-PEEP effect can be detected and quantified by a simple bedside maneuver: expiratory port occlusion at the end of the set exhalation period.
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              Autoresuscitation after asystole in patients being considered for organ donation.

              A fundamental issue in organ donation after circulatory death is the determination of death. There are limited data regarding the incidence and timing of autoresuscitation after asystole. Prevailing guidelines suggest a 2- to 5-min observation after mechanical asystole before the declaration of death. This study tested the hypothesis that a 2-min observation period after asystole is sufficient for the declaration of death in patients being considered for organ donation after circulatory death.
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                Author and article information

                Contributors
                Journal
                Case Rep Crit Care
                Case Rep Crit Care
                CRICC
                Case Reports in Critical Care
                Hindawi
                2090-6420
                2090-6439
                2022
                15 February 2022
                : 2022
                : 3322056
                Affiliations
                Internal Medicine Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
                Author notes

                Academic Editor: Zsolt Molnár

                Author information
                https://orcid.org/0000-0002-5581-3901
                Article
                10.1155/2022/3322056
                8863492
                5d94b59a-4cdc-4c74-b6a2-ec387f6341b3
                Copyright © 2022 Waqar Haider Gaba et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 1 July 2021
                : 3 February 2022
                : 4 February 2022
                Categories
                Case Report

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