• Stephen Mullen, Zöe Roberts, David Tuthill, Laura Owens, Johann Te Water Naude, and Sabine Maguire.
• From the Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, N. Ireland.
• Pediatr Emerg Care. 2021 Apr 1; 37 (4): e210e211e210-e211.

AbstractPediatric autoresuscitation is extremely rare, with only 4 documented cases in the literature. The longest recorded time between stopping cardio pulmonary resuscitation (CPR) and return of spontaneous circulation is 2 minutes. We report a previously well 18-month-old who attended the emergency department after an unexplained cardiac arrest. After 10 cycles of CPR, resuscitation was stopped; 6 minutes later, the patient had a return of spontaneous circulation and was transferred to the pediatric intensive care unit. The patient remains alive but with significant neurological impairment. There are a variety of theories regarding the pathology of pediatric autoresuscitation. The most commonly accepted model is that there is a degree of autopositive end-expiratory pressure impending venous return as a consequence of vigorous ventilation during CPR. This case challenges clinicians to reassess our current definition of death and reaffirms the need for clearer guidelines surrounding the certification of death.Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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