Pralidoxime-Induced Potentiation of the Pressor Effect of Adrenaline and Hastened Successful Resuscitation by Pralidoxim

  • PDF / 1,372,788 Bytes
  • 10 Pages / 595.276 x 790.866 pts Page_size
  • 51 Downloads / 123 Views

DOWNLOAD

REPORT


ORIGINAL ARTICLE

Pralidoxime-Induced Potentiation of the Pressor Effect of Adrenaline and Hastened Successful Resuscitation by Pralidoxime in a Porcine Cardiac Arrest Model Hyoung Youn Lee 1 & Najmiddin Mamadjonov 2 & Kyung Woon Jeung 3,4 Kyung-Sub Moon 4,5 & Tag Heo 1,4 & Yong Il Min 1,4

&

Yong Hun Jung 1,4 & Byung Kook Lee 1,4 &

Accepted: 9 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract Purpose Pralidoxime potentiated the pressor effect of adrenaline and facilitated restoration of spontaneous circulation (ROSC) after prolonged cardiac arrest. In this study, we hypothesised that pralidoxime would hasten ROSC in a model with a short duration of untreated ventricular fibrillation (VF). We also hypothesised that potentiation of the pressor effect of adrenaline by pralidoxime would not be accompanied by worsening of the adverse effects of adrenaline. Methods After 5 min of VF, 20 pigs randomly received either pralidoxime (40 mg/kg) or saline, in combination with adrenaline, during cardiopulmonary resuscitation (CPR). Coronary perfusion pressure (CPP) during CPR, and ease of resuscitation were compared between the groups. Additionally, haemodynamic data, severity of ventricular arrhythmias, and cerebral microcirculation were measured during the 1-h post-resuscitation period. Cerebral microcirculatory blood flow and brain tissue oxygen tension (PbtO2) were measured on parietal cortices exposed through burr holes. Results All animals achieved ROSC. The pralidoxime group had higher CPP during CPR (P = 0.014) and required a shorter duration of CPR (P = 0.024) and smaller number of adrenaline doses (P = 0.024). During the post-resuscitation period, heart rate increased over time in the control group, and decreased steadily in the pralidoxime group. No inter-group differences were observed in the incidences of ventricular arrhythmias, cerebral microcirculatory blood flow, and PbtO2. Conclusion Pralidoxime improved CPP and hastened ROSC in a model with a short duration of untreated VF. The potentiation of the pressor effect of adrenaline was not accompanied by the worsening of the adverse effects of adrenaline. Keywords Heart arrest . Cardiopulmonary resuscitation . Pralidoxime . Epinephrine

Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07026-5) contains supplementary material, which is available to authorized users. * Kyung Woon Jeung [email protected] 1

Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea

2

Department of Medical Science, Chonnam National University Graduate School, Gwangju, Republic of Korea

3

Department of Emergency Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea

4

Department of Emergency Medicine, Chonnam National Univeristy Medical School, Gwangju, Republic of Korea

5

Department of Neurosurgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea

Introducti