PURPOSE: Cardiopulmonary resuscitation (CPR) may induce a systemic inflammatory response not necessarily due to sepsis. The purpose of this study was to examine short-term changes in WBC, PMN and bands associated with CPR in subjects with no discernible infection.
METHODS: We conducted a retrospective analysis of 864 CPR from 2001 to 2009, inclusive. From these, 194 subjects in whom a negative septic workup (blood, urine, sputum, wound cultures etc., five days before and after CPR) were included in the study. We evaluated WBC, PMN and bands in the period from the day before CPR (Day -1), during or immediately after CPR (Day 0) and the two days post-CPR (Day +1 and Day +2). The Kruskal-Wallis test with Dunn’s test post hoc were used to assess statistical significance (α = 0.05; two-tailed p ≤ 0.05 required). Data below are medians with inter-quartile ranges (IQR) in parentheses.
RESULTS: WBC increased significantly (p< 0.05) after CPR, with Day -1: 10.60 cells/mm3 (7.40 to 13.33 cells/mm3) and Day 0: 15.45 cells/mm3 (12.50 to 21.18 cells/mm3). During the same period both PMN and bands demonstrated significant increases with PMN on Day -1: 70% (60 to 79%) to Day 0: 84% (75 to 89%, p< 0.05); bands on Day -1: 0% (0 to 1.0%) to Day 0: 7.0% (3.0 to 13.3%; p< 0.05). In the two-day period post-CPR, WBC decreased slightly to 13.10 cells/mm3 (9.75 to 18.95 cells/mm3; p> 0.05). A similar trend was observed for PMN, which decreased to 80% (70.5 to 86%, p>0.05). Bands, however, decreased significantly from Day 0 to Day +1: 3% (0 to 7%; p< 0.05) and Day +2: 1% (0 to 3%; p< 0.05).
CONCLUSION: CPR results in a systemic inflammatory response and can manifest as a significant increase in WBC, PMN and bands. This response subsides to varying extents in the 2-day period following CPR.
CLINICAL IMPLICATIONS: Post-CPR, subjects may not require antibiotics, as the increase in PMN turnover likely results from the activity of pro-inflammatory cytokines.
DISCLOSURE: ARYA KARKI, No Financial Disclosure Information; No Product/Research Disclosure Information