Because the patient had MRSA and CPR was performed without proper infection control measures, the physician involved in the CPR went to shower and change clothes, leaving the patient still being ventilated in the intensive care unit. In one report, CPR was terminated after 30 minutes and the patient was in asystole. One could argue that in the presence of decreased cardiac output-as in myocardial infarction and hypovolaemia-dynamic hyperinflation could compromise the cardiac output even more, leading to cardiac arrest.Įven though auto-PEEP due to dynamic hyperinflation seems most plausible and has some evidence in patients with obstructive airways disease, this alone would not explain all cases of delayed ROSC.
#LAZARUS MEANING MANUAL#
Dynamic hyperinflation can theoretically happen in any situation where rapid manual ventilation is carried out. It is tempting to apply this theory even to patients without obstructive airways disease. Some authors recommend discontinuing the ventilation transiently for 10 to 30 seconds in PEA to allow venous return. Hypovolaemia and decreased myocardial contractility could exaggerate its effect on venous return and cardiac output. Auto-PEEP is a possible cause of pulseless electrical activity (PEA), and rapid ventilation during CPR should be avoided. The physiology of severe auto-PEEP is similar to pericardial tamponade, where circulation can only be restored after removing the obstacle to cardiac filling. The ventilator was adjusted to a respiratory rate of six breaths per minute and a tidal volume of 400 mL and the blood pressure gradually rose to 126/84 mm Hg. Even after inotropes the systolic blood pressure did not exceed 70 mm Hg. 31 One report describes a patient with respiratory failure due to asthma whose blood pressure was undetectable five minutes after initiating artificial ventilation with a tidal volume of 700 mL and respiratory rate of 25 breaths per minute. The link between mechanical ventilation of patients with obstructive ventilatory defects and circulatory failure was first demonstrated in 1982. Dynamic hyperinflation may lead to gas trapping and an increase in the end-expiratory pressure (called auto-PEEP) leading to delayed venous return, low cardiac output and even cardiac arrest in patients with obstructive airways disease. The imagery of the video surely took on a deeper meaning for the now terminal-ill singer.Rapid manual ventilation without adequate time for exhalation during CPR can lead to dynamic hyperinflation of lungs.
I found out later that, the week we were shooting, it was when he was told it was over, they were ending treatments and that his illness had won" (via The Guardian). "To me it had to do with the biblical aspect of it. I immediately said 'the song is called "Lazarus," you should be in the bed.'" But little did he know that the video would come to represent the deathbed scene of one of pop music's biggest stars. "David said: 'I just want to make it a simple performance video'. According to a close friend, the singer kept his illness a secret while he underwent over a year of treatment.įilmmaker Johan Renck was the director on the music video for "Lazarus," and recalls the tragic timing of the October 2015 filming. Sadly, unknown to the majority of David Bowie's friends and collaborators at the time, the musician was also coping with liver cancer, which had first been diagnosed in 2014, per The New Zealand Herald.
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