P0551 - Lazarus Syndrome in Pediatric Hospice Care: Does It Occur and What Home Hospice Providers Should Know?

Background: Lazarus syndrome, also known as autoresuscitaiton, is a unique situation following asystole and the prounouncement of death when patients achieve return of spontaneous circulation and respiration. It is rarely long lived and permanent death typically ensues minutes/hours later although longer survival may occur.

Objective: To report on this rare phenomenon in two pediatric patients receiving end of life care, so that pediatric providers recognize this phenomenon in children separate from the reports of failed CPR leading to Lazarus syndrome.

Design/

Methods: Case reports of two patients receiving comfort care measures in antitipcation of death.

Results: Two patients who presented with profound neurodevelopmental disability, progressed to asystole and
experienced autoresuscitation.

Case #1: 16-yo Latino male with spastic quadraplegia and profound cognitive impairment after birth asphyxia presented in septic shock to a tertiary PICU. A DNR order was executed. He was stabilized but progressed to MODS and care was focused on comfort only, ultimately progressing to asystole. The ICU attending pronounced death after auscultation and observation of no pulsatile activity on A-line nor EKG activity on the
bedside monitor, which was then turned off. Several minutes passed after telling the mother that "he was gone." Then the mother noticed a gasp and said, "What's that?" He resumed spontaneous respirations, the monitor was turned back on, demonstrating EKG and pulse oximeter activity. He remained alive, recovered and was discharged from the ICU in his previous state of disability without techonology support. Coincidentally,
it was Easter Day.

Case #2: 23-mo Latino male with Menke's disease with progressive deterioration on home hospice care. He developed agonal respirations at 6 am. The hospice nurse arrived at 6:21am. Two nurses confirmed absence of breathing and cardiac activity by auscultation. At 6:35 am, he was in his mother's arms and started breathing with HR=180. At 10:10 am he ceased breathing and had no detectable cardiac activity. The medical director reassured the family and the nurses, who were quite distressed in both cases, that autoresuscitation does occur occasionally. The family and nurses were comforted to know this has been seen before.

Conclusion(s): Autoresuscitation occurs in pediatric ICUs and home hospice patients. Awareness of this phenomenon and preparation of staff are important roles for palliative care consultants and ICU clinicians.