To the Editor:-The case report by Frolich is one of the best documented cases of spontaneous recovery after discontinuation of cardiopulmonary resuscitation (CPR).  More than 25 such cases have been reported, including at least eight patient discharged neurologically intact.  One case published in Anesthesiology introduced the term "Lazarus phenomenon" for such events.  However, we would argue that the case of Harden et al.  should not be regarded as a true Lazarus phenomenon because there is no indication that CPR had been stopped at the time when spontaneous conversion of ventricular fibrillation occurred.
With regard to prevention of Lazarus phenomena, Frolich suggests to continue CPR until ineffectiveness has been shown by a decreasing pH with adequate ventilation.  Although this approach is probably correct, there are no defined pH values below which resuscitation can be considered futile. In the case of Fumeaux et al.,  the patient survived neurologically intact after cessation of CPR at a pH of 6.54. An alternative approach might be end-tidal carbon dioxide. Its use for therapeutic and prognostic decisions during CPR was first proposed by Eisenmenger, [6,7] first used in humans by Leigh et al.,  and studied in detail by Smalhout.  In the last 20 years there have been several studies on capnography during CPR.  Values greater than 10–15 mmHg indicate a favorable prognosis and should preclude termination of CPR. Unfortunately, there are no capnography data in the Lazarus cases published to date, including ours and that of Frolich. [1,2]
Wolfgang H. Maleck, A.R.Z.T.
Swen N. Piper, M.D.
Department of Anesthesiology; Klinikum; D-67063 Ludwigshafen, Germany;email@example.com
(Accepted for publication March 25, 1999.)