A patient in whom self-terminating ventricular fibrillation was a manifestation of myocardial reperfusion

Autoresuscitation (Lazarus phenomenon) after termination of cardiopulmonary resuscitation - a scoping review

BACKGROUND

Autoresuscitation describes the return of spontaneous circulation after termination of resuscitation (TOR) following cardiac arrest (CA). We aimed to identify phenomena that may lead to autoresuscitation and to provide guidance to reduce the likelihood of it occurring.

MATERIALS AND METHODS

We conducted a literature search (Google Scholar, MEDLINE, PubMed) and a scoping review according to PRISMA-ScR guidelines of autoresuscitation cases where patients undergoing CPR recovered circulation spontaneously after TOR with the following criteria: 1) CA from any cause; 2) CPR for any length of time; 3) A point was reached when it was felt that the patient had died; 4) Staff declared the patient dead and stood back. No further interventions took place; 5) Later, vital signs were observed. 6) Vital signs were sustained for more than a few seconds, such that staff had to resume active care.

RESULTS

Sixty-five patients with ROSC after TOR were identified in 53 articles (1982-2018), 18 (28%) made a full recovery.

CONCLUSIONS

Almost a third made a full recovery after autoresuscitation. The following reasons for and recommendations to avoid autoresuscitation can be proposed: 1) In asystole with no reversible causes, resuscitation efforts should be continued for at least 20 min; 2) CPR should not be abandoned immediately after unsuccessful defibrillation, as transient asystole can occur after defibrillation; 3) Excessive ventilation during CPR may cause hyperinflation and should be avoided; 4) In refractory CA, resuscitation should not be terminated in the presence of any potentially-treatable cardiac rhythm; 5) After TOR, the casualty should be observed continuously and ECG monitored for at least 10 min.

Self-terminating ventricular fibrillation recorded by an implantable loop recorder as a cause of syncope - A case report

Ventricular fibrillation (VF) is the most common arrhythmia leading to sudden cardiac death, but in rare cases VF can manifest as a syncope, provided that it will self-terminate. We present a case of a 45-year old female with a history of unexplained syncopal episodes despite exhaustive diagnostics. Implantable loop recorder documented an episode of idiopathic, self-terminating VF as a cause of syncope.

Self-termination of ventricular fibrillation during transport by emergency medical service

Ventricular fibrillation (VF) is usually sustained, and it typically results in death unless electrical defibrillation is successfully performed within minutes. Although VF has been reported to spontaneously occur in vivo in some animal models and a few cases of self-terminating VF have been documented in clinical practice, no such case has been previously reported involving out-of-hospital emergency medical service(EMS) personnel. We report a case of self-terminating VF due to ST segment elevation myocardial infarction that was documented by continuous electrocardiogram (ECG) strip monitoring. A 70-year-old woman was transported to the emergency department by EMS due to chest discomfort. The EMS personnel monitored her by ECG using an automated external defibrillator with a 3-limb lead. During transport, she developed VF, which persisted for 43 seconds. Chest compression and defibrillation were not applied. The VF self-terminated, after which the patient promptly awoke. Emergency coronary angiography was performed,and a total occlusion of the middle left circumflex coronary artery was treated by percutaneous coronary intervention. Since then, no symptomatic arrhythmia or ST-segment change was detected by continuous ECG monitoring. The patient was discharged home without any sequelae on the fourth hospital day.

Spontaneous termination of ventricular fibrillation in a patient with congenital coronary anomaly

Sudden death is common in patients with congenital coronary artery anomalies mainly when the left main coronary artery originates from the right coronary sinus. Ventricular fibrillation in these patients is irreversible unless defibrillation can be rapidly performed. We describe a 57-year-old male with an anomalous origin of circumflex and the left anterior descending coronary arteries from the right coronary sinus. He developed two episodes of ventricular fibrillation that terminated spontaneously, 10 hours after percutaneous revascularization of the circumflex coronary artery. Computed tomography angiography, in addition to confirming the anomalous origin of the coronary arteries, showed a muscle bridge over the midportion of the left anterior descending coronary artery. This is the first report of spontaneous termination of ventricular fibrillation in a patient with congenital anomaly of the coronary arteries.

Spontaneous defibrillation after cessation of resuscitation in out-of-hospital cardiac arrest: A case of Lazarus phenomenon

This report describes a case of out-of-hospital cardiac arrest with spontaneous defibrillation and subsequent return of circulation after cessation of resuscitative efforts. A 47-year-old man was found in cardiac arrest and resuscitation was initiated. As no response was achieved, the efforts were withdrawn and final registered cardiac rhythm was ventricular fibrillation. Fifteen minutes later the patient was found to be normotensive and breathing spontaneously. The patient made a poor neurological recovery and died 3 months after the arrest. The authors are unable to give an explanation to the event, but suspect the effect of adrenaline combined with mild hypothermia to have contributed to the self-defibrillation of the myocardium.

Torsades de pointes and self-terminating ventricular fibrillation in a prescription methadone user

Methadone is known to prolong the QT interval and precipitate torsades de pointes. A 54-year-old prescription methadone user with hypokalaemia was referred to Critical Care with acute confusion and respiratory distress. Alcohol withdrawal was the presumed precipitant. The real precipitant only became evident on analysis of a 24-h ECG (Holter monitor) attached to the patient at the time. The patient had suffered prolonged (10 min) ventricular arrhythmias including torsades de pointes and self-terminating ventricular fibrillation. The patient made a full recovery. Risk factors for acquired long QT syndrome and the treatment of torsades de pointes are discussed.

Transient ventricular fibrillation. A clinical case report

Self-terminating ventricular fibrillation (VF) was recorded in a 42-year-old woman without coronary artery or structural heart disease. Reviewing the scientific literature, we found that this type of VF had appeared in vivo in some animal models but was sparsely described in clinical practice. This most unusual case shows that potentially lethal arrhythmias may be self-terminating.

Cardiopulmonary resuscitation: new European guidelines

Cardiac arrest is the ultimate medical emergency. Without rapid action by witnesses and responding health professionals, chances of survival are remote. In this article the key evidence-based aspects of resuscitation, basic life support and early defibrillation are discussed in light of the recent publication of revised guidelines from the European Resuscitation Council. The importance of calling for skilled help at the earliest opportunity is emphasized, facilitating rapid access to emergency services (in the community) and the cardiac arrest team (in hospital). The advent of the automated external defibrillator (AED) presents additional opportunities to save lives and it is recommended that registered nurses are trained in, and authorized to use, AEDs in their professional practice.

Self-terminating ventricular fibrillation during variant angina--a case report

The authors present a case report of self-terminating ventricular fibrillation during an episode of variant angina. The causes of ventricular fibrillation in this disorder and the possible mechanisms for its rare spontaneous interruption are discussed.