Her heart had stopped beating and she was no longer breathing. Janina Kolkiewicz was alleged dead. At 91 years former, she had lived a long life. But she was non about to stop living it. 11 hours later, she awoke in the infirmary mortuary with a craving for tea and pancakes. Equally inconceivable as it sounds, Kolkiewicz is just one of many people said to have "risen from the dead."

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There accept been a number of cases whereby patients' vital signs have returned after being declared dead.

In 2001, a 66-twelvemonth-onetime man experienced cardiac arrest while undergoing surgery for an abdominal aneurysm.

Later 17 minutes of resuscitation efforts – incorporating CPR, defibrillation, and medication – the human's vital signs failed to return, and he was pronounced dead. 10 minutes afterwards, his surgeon felt a pulse. He was alive. The homo's operation continued, with a successful outcome.

In 2014, a 78-yr-old human from Mississippi was declared dead later on a hospice nurse found him with no pulse. The side by side day, he woke up in a trunk purse at the morgue.

These are undoubtedly extraordinary stories that audio more suited to a horror motion picture, but at that place is a real-world proper name for such cases: Lazarus syndrome.

The Lazarus phenomenon, or Lazarus syndrome, is defined every bit a delayed render of spontaneous circulation (ROSC) after CPR has ceased. In other words, patients who are pronounced expressionless after cardiac arrest experience an impromptu render of cardiac activeness.

The syndrome is named after Lazarus of Bethany, who – according to the New Testament of the Bible – was brought back to life by Jesus Christ 4 days after his death.

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Lazarus syndrome is the return of spontaneous circulation after CPR has been stopped.

Since 1982, when the Lazarus miracle was get-go described in medical literature, there take been at to the lowest degree 38 reported cases.

According to a 2007 report by Vedamurthy Adhiyaman and colleagues, in around 82 pct of Lazarus syndrome cases to date, ROSC occurred within 10 minutes of CPR beingness stopped, and around 45 percent of patients experienced good neurological recovery.

But while the low number of report cases might highlight the rarity of Lazarus syndrome, scientists believe that it is much more mutual than studies propose.

"The Lazarus phenomenon is a grossly underreported event," notes Maxillofacial Surgeon Dr. Vaibhav Sahni in a 2016 report.

"The reason for these can be attributed to the fact that medicolegal issues are brought to lite in cases which are pronounced expressionless which after plough out to have been alive," he explains. "The professional expertise of the resuscitating doctor can be brought into question, not to mention the fact that such an upshot tin can lead to disrepute amid colleagues."

"Some other pertinent question that arises is whether the death of a particular patient occurred as a result of premature cessation of resuscitative efforts or the omission of continued resuscitation," he adds.

Precisely what causes the Lazarus phenomenon remains unclear, but at that place are some theories.

Some researchers suggest that the Lazarus miracle may be down to a pressure buildup in the chest caused by CPR. Once CPR is ceased, this pressure level may gradually release and kicking-start the heart back into activeness.

Another theory is the delayed activity of medication used as a part of resuscitation efforts, such equally adrenaline.

"It is possible that drugs injected through a peripheral vein are inadequately delivered centrally due to impaired venous return, and when venous render improves afterward stopping the dynamic hyperinflation, commitment of drugs could contribute to return of circulation," explicate Adhiyaman and colleagues.

Hyperkalemia – whereby blood levels of potassium are as well high – is another proposed explanation for the Lazarus miracle, equally information technology has been linked to delayed ROSC.

Considering so few cases of Lazarus syndrome are reported, uncovering the exact mechanisms behind the status is tricky.

But maybe it is not what is bringing a patient dorsum to life that we should be concerned virtually; perchance they were never deceased.

As Benjamin Franklin once said, "In this world cypher is certain but death and taxes." In a clinical setting, however, a declaration of death is not as certain as 1 might think.

In 2014 came a report of an 80-year-old woman who had been "frozen alive" in a hospital morgue after existence wrongly pronounced dead.

In the same year, a New York Hospital came under burn after incorrectly declaring a woman as brain dead following a drug overdose. The woman awoke shortly after being taken to the operating room for organ harvesting.

Cases such as these beg the question, how is it even possible to mistakingly declare a person as dead?

At that place are two types of death: clinical death and biological expiry. Clinical death is defined as the absenteeism of a pulse, heartbeat, and breathing, while biological decease is defined as the absenteeism of brain action.

Looking at these definitions, you lot might presume that it would exist easy to tell when a person is deceased – merely in some cases, it is not so elementary.

There are a number of medical conditions that tin can brand an individual "announced" dead.

One such condition is hypothermia, whereby the body experiences a sudden, potentially fatal drop in temperature, normally caused by prolonged exposure to the cold.

Hypothermia can cause heartbeat and breathing to slow, to the point where information technology is nearly undetectable. Information technology is believed that hypothermia led to the mistaken death of a newborn baby in Canada in 2013.

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There are a number of atmospheric condition in which a patient might 'appear' to exist deceased.

The baby in question was born on a sidewalk in freezing cold temperatures. Doctors were unable to detect a pulse, and the babe was declared dead. Two hours later, the infant started moving.

Dr. Michael Klein, of the University of British Columbia in Canada, said that the baby'south exposure to such common cold temperatures may explicate the situation. "The whole circulation would take stopped simply the neurological condition of the kid could be protected by the cold."

Catalepsy and locked-in syndrome are examples of other weather condition in which the living could be mistaken for expressionless.

Catalepsy is characterized by a trance-like state, slowed breathing, reduced sensitivity, and complete immobility, which tin can last from minutes to weeks. The status may ascend equally a symptom of neurological disorders such equally epilepsy and Parkinson's disease.

In locked-in syndrome, a patient is aware of their surroundings, merely they feel consummate paralysis of voluntary muscles, with the exception of muscles that control middle movement.

In 2014, The Daily Mail reported on 39-year-onetime British woman Kate Allatt, who had locked-in syndrome.

Unaware of her status, doctors declared her brain dead. Medics, family, and friends stood past her bedside and discussed whether or non to switch off her life support. Allatt heard everything, but she was unable to tell them that she was fully witting.

"Locked-in syndrome is like being cached live," said Allatt. "You can think, you lot can experience, you lot can hear, merely you can communicate absolutely nothing."

If this commodity has sent a shiver down your spine, fright non; Lazarus syndrome is extremely rare, as is the possibility of existence wrongly declared as deceased.

That said, the fact that such cases have even occurred has raised questions near death recognition and confirmation in a clinical setting.

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Some researchers advise that doctors should wait x minutes later on CPR is stopped to come across whether a patient'southward vital signs return.

Co-ordinate to Adhiyaman and colleagues, some researchers have suggested that patients should be "passively monitored" for 10 minutes following death, as that is the fourth dimension frame in which delayed ROSC is well-nigh likely to occur.

"Expiry should not exist certified in any patient immediately afterward stopping CPR," the researchers write, "and one should wait at least 10 minutes, if not longer, to verify and ostend death beyond doubt."

When information technology comes to organ donation, however, other researchers note that waiting as long as 10 minutes to come across whether ROSC might occur could exist detrimental.

Current guidelines recommend 2 to 5 minutes of ascertainment after the heart has stopped beating before declaring death; the longer the blood menstruum to the organs is restricted, the less likely they are to be suitable for donation.

With this in mind, it is unlikely that protocols surrounding death confirmation will change someday soon.

But healthcare professionals and researchers alike are in full general agreement that in this day and historic period, physicians have the expertise and medical equipment to effectively determine when a patient has passed.