Clin Exp Emerg Med.  2019 Sep;6(3):204-211. 10.15441/ceem.18.036.

Effect of pralidoxime on coronary perfusion pressure during cardiopulmonary resuscitation in a pig model

Affiliations
  • 1Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea. neoneti@hanmail.net
  • 2Biomedical Research Institute, Chonnam National University Hospital, Gwangju, Korea.

Abstract


OBJECTIVE
Pralidoxime is widely used for the treatment of organophosphate poisoning. Multiple studies have reported its vasoconstrictive property, which may facilitate the restoration of spontaneous circulation (ROSC) after cardiac arrest by increasing the coronary perfusion pressure (CPP). 2,3-Butanedione monoxime, which belongs to the same oxime family, has been shown to facilitate ROSC by reducing left ventricular ischemic contracture. Because pralidoxime and 2,3-butanedione monoxime have several common mechanisms of action, both drugs may have similar effects on ischemic contracture. Thus, we investigated the effects of pralidoxime administration during cardiopulmonary resuscitation in a pig model with a focus on ischemic contracture and CPP.
METHODS
After 14 minutes of untreated ventricular fibrillation, followed by 8 minutes of basic life support, 16 pigs randomly received either 80 mg/kg of pralidoxime (pralidoxime group) or an equivalent volume of saline (control group) during advanced cardiovascular life support (ACLS).
RESULTS
Mixed-model analyses of left ventricular wall thickness and chamber area during ACLS revealed no significant group effects or group-time interactions, whereas a mixed-model analysis of the CPP during ACLS revealed a significant group effect (P=0.038) and group-time interaction (P<0.001). Post-hoc analyses revealed significant increases in CPP in the pralidoxime group, starting at 5 minutes after pralidoxime administration. No animal, except one in the pralidoxime group, achieved ROSC; thus, the rate of ROSC did not differ between the two groups.
CONCLUSION
In a pig model of cardiac arrest, pralidoxime administered during cardiopulmonary resuscitation did not reduce ischemic contracture; however, it significantly improved CPP.

Keyword

Heart arrest; Cardiopulmonary resuscitation; Perfusion; Hemodynamics

MeSH Terms

Animals
Cardiopulmonary Resuscitation*
Diacetyl
Heart Arrest
Hemodynamics
Humans
Ischemic Contracture
Organophosphate Poisoning
Perfusion*
Swine
Ventricular Fibrillation
Diacetyl
Full Text Links
  • CEEM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error