nach oben

Erschienen in:

19.06.2020 | Original Article

Pralidoxime-Induced Potentiation of the Pressor Effect of Adrenaline and Hastened Successful Resuscitation by Pralidoxime in a Porcine Cardiac Arrest Model

verfasst von: Hyoung Youn Lee, Najmiddin Mamadjonov, Kyung Woon Jeung, Yong Hun Jung, Byung Kook Lee, Kyung-Sub Moon, Tag Heo, Yong Il Min

Erschienen in: Cardiovascular Drugs and Therapy | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

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.

Nur mit Berechtigung zugänglich

Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med. 2018;379:711–21.CrossRef

Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, et al. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972–80.CrossRef

Eddleston M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F, et al. Pralidoxime in acute organophosphorus insecticide poisoning–a randomised controlled trial. PLoS Med. 2009;6:e1000104.CrossRef

Jung YH, Ryu DH, Jeung KW, Na JY, Lee DH, Lee BK, et al. Effect of pralidoxime on coronary perfusion pressure during cardiopulmonary resuscitation in a pig model. Clin Exp Emerg Med. 2019;6:204–11.CrossRef

Jung YH, Lee HY, Jeung KW, Lee BK, Youn CS, Yun SW, et al. Pralidoxime administered during cardiopulmonary resuscitation facilitates successful resuscitation in a pig model of cardiac arrest. Clin Exp Pharmacol Physiol. 2020;47:236–46.CrossRef

Jung YH, Mamadjonov N, Lee HY, et al. Effects of different doses of Pralidoxime administered during cardiopulmonary resuscitation and the role of α-adrenergic receptors in its Pressor action. J Am Heart Assoc. 2020;9:e015076.PubMedPubMedCentral

Wenzel V, Lindner KH, Krismer AC, Miller EA, Voelckel WG, Lingnau W. Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prolonged cardiopulmonary resuscitation in pigs. Circulation. 1999;99:1379–84.CrossRef

Jeung KW, Ryu HH, Song KH, Lee BK, Lee HY, Heo T, et al. Variable effects of high-dose adrenaline relative to standard-dose adrenaline on resuscitation outcomes according to cardiac arrest duration. Resuscitation. 2011;82:932–6.CrossRef

Berg RA, Otto CW, Kern KB, Hilwig RW, Sanders AB, Henry CP, et al. A randomized, blinded trial of high-dose epinephrine versus standard-dose epinephrine in a swine model of pediatric asphyxial cardiac arrest. Crit Care Med. 1996;24:1695–700.CrossRef

10.

Tang W, Weil MH, Sun S, Noc M, Yang L, Gazmuri RJ. Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation. 1995;92:3089–93.CrossRef

11.

Ristagno G, Sun S, Tang W, Castillo C, Weil MH. Effects of epinephrine and vasopressin on cerebral microcirculatory flows during and after cardiopulmonary resuscitation. Crit Care Med. 2007;35:2145–9.CrossRef

12.

Ristagno G, Tang W, Huang L, Fymat A, Chang YT, Sun S, et al. Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation. Crit Care Med. 2009;37:1408–15.CrossRef

13.

Schmitz B, Fischer M, Bockhorst K, Hoehn-Berlage M, Hossmann KA. Resuscitation from cardiac arrest in cats: influence of epinephrine dosage on brain recovery. Resuscitation. 1995;30:251–62.CrossRef

14.

Berg RA, Otto CW, Kern KB, et al. High-dose epinephrine results in greater early mortality after resuscitation from prolonged cardiac arrest in pigs: a prospective, randomized study. Crit Care Med. 1994;22:282–90.CrossRef

15.

Gedeborg R, Silander HC, Ronne-Engström E, Rubertsson S, Wiklund L. Adverse effects of high-dose epinephrine on cerebral blood flow during experimental cardiopulmonary resuscitation. Crit Care Med. 2000;28:1423–30.CrossRef

16.

Cho YC, Cho SW, Chung SP, Yu K, Kwon OY, Kim SW. How can a single rescuer adequately deliver tidal volume with a manual resuscitator? An improved device for delivering regular tidal volume. Emerg Med J. 2011;28:40–3.CrossRef

17.

Curtis MJ, Hancox JC, Farkas A, Wainwright CL, Stables CL, Saint DA, et al. The Lambeth Conventions (II): guidelines for the study of animal and human ventricular and supraventricular arrhythmias. Pharmacol Ther. 2013;139:213–48.CrossRef

18.

Le Roux P, Menon DK, Citerio G, et al. Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1189–209.CrossRef

19.

Spronk PE, Ince C, Gardien MJ, Mathura KR, Oudemans-van Straaten HM, Zandstra DF. Nitroglycerin in septic shock after intravascular volume resuscitation. Lancet. 2002;360:1395–6.CrossRef

20.

Boerma EC, Mathura KR, van der Voort PH, Spronk PE, Ince C. Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study. Crit Care. 2005;9:R601–6.CrossRef

21.

Serné EH, Gans RO, ter Maaten JC, Tangelder GJ, Donker AJ, Stehouwer CD. Impaired skin capillary recruitment in essential hypertension is caused by both functional and structural capillary rarefaction. Hypertension. 2001;38:238–42.CrossRef

22.

Reynolds JC, Frisch A, Rittenberger JC, Callaway CW. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation. 2013;128:2488–94.CrossRef

23.

Iqbal MB, Al-Hussaini A, Rosser G, et al. Predictors of survival and favorable functional outcomes after an out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack center (from the Harefield Cardiac Arrest Study). Am J Cardiol. 2015;115:730–7.CrossRef

24.

Dumas F, Bougouin W, Geri G, Lamhaut L, Bougle A, Daviaud F, et al. Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients? J Am Coll Cardiol. 2014;64:2360–7.CrossRef

25.

Sigal AP, Sandel KM, Buckler DG, Wasser T, Abella BS. Impact of adrenaline dose and timing on out-of-hospital cardiac arrest survival and neurological outcomes. Resuscitation. 2019;139:182–8.CrossRef

26.

Zarro VJ, Dipalma JR. The sympathomimetic effects of 2-pyridine aldoxime methylchloride (2-PAM CL). J Pharmacol Exp Ther. 1965;147:153–60.PubMed

27.

Stavinoha WB, Hinshaw LB, Smith PW, Rieger JA Jr. Cardiovascular effects of 2-pyridine aldoxime methylchloride (pralidoxime and blood pressure). Arch Int Pharmacodyn Ther. 1970;187:52–65.PubMed

28.

Carrier GO, Peters T, Bishop VS. Alteration in calcium metabolism as a mechanism for pyridine aldoxime methochloride (2-PAM) cardiac action in rabbit atria. J Pharmacol Exp Ther. 1975;193:218–31.PubMed

29.

Vandycke C, Martens P. High dose versus standard dose epinephrine in cardiac arrest - a meta-analysis. Resuscitation. 2000;45:161–6.CrossRef

30.

Lin S, Callaway CW, Shah PS, Wagner JD, Beyene J, Ziegler CP, et al. Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials. Resuscitation. 2014;85:732–40.CrossRef

31.

Yang L, Wang S, Li CS. Effect of continuous compression and 30:2 cardiopulmonary resuscitation on cerebral microcirculation in a porcine model of cardiac arrest. Scand J Trauma Resusc Emerg Med. 2013;21:55.CrossRef

32.

Sekhon MS, Gooderham P, Menon DK, Brasher PMA, Foster D, Cardim D, et al. The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest. Crit Care Med. 2019;47:960–9.CrossRef

33.

Elmer J, Flickinger KL, Anderson MW, Koller AC, Sundermann ML, Dezfulian C, et al. Effect of neuromonitor-guided titrated care on brain tissue hypoxia after opioid overdose cardiac arrest. Resuscitation. 2018;129:121–6.CrossRef

34.

Sekhon MS, Ainslie PN, Menon DK, Thiara SS, Cardim D, Gupta AK, et al. Brain hypoxia secondary to diffusion limitation in hypoxic ischemic brain injury postcardiac arrest. Crit Care Med. 2020;48:378–84.CrossRef

35.

Markstaller K, Karmrodt J, Doebrich M, Wolcke B, Gervais H, Weiler N, et al. Dynamic computed tomography: a novel technique to study lung aeration and atelectasis formation during experimental CPR. Resuscitation. 2002;53:307–13.CrossRef

36.

Cha KC, Kim YW, Kim HI, Kim OH, Cha YS, Kim H, et al. Parenchymal lung injuries related to standard cardiopulmonary resuscitation. Am J Emerg Med. 2017;35:117–21.CrossRef

37.

Tang W, Weil MH, Gazmuri RJ, Sun S, Duggal C, Bisera J. Pulmonary ventilation/perfusion defects induced by epinephrine during cardiopulmonary resuscitation. Circulation. 1991;84:2101–7.CrossRef

38.

Berk JL, Hagen JF, Koo R, et al. Pulmonary insufficiency caused by epinephrine. Ann Surg. 1973;178:423–35.CrossRef

39.

Ferrari W, Baggio G, Guarini S. Studies on epinephrine-induced lung edema in the rat. I. Selective alpha 1-adrenoceptor involvement. Arch Int Pharmacodyn Ther. 1986;281:89–99.PubMed

40.

Laurent I, Monchi M, Chiche JD, Joly LM, Spaulding C, Bourgeois B, et al. Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol. 2002;40:2110–6.CrossRef

Titel: Pralidoxime-Induced Potentiation of the Pressor Effect of Adrenaline and Hastened Successful Resuscitation by Pralidoxime in a Porcine Cardiac Arrest Model
verfasst von: Hyoung Youn Lee
Najmiddin Mamadjonov
Kyung Woon Jeung
Yong Hun Jung
Byung Kook Lee
Kyung-Sub Moon
Tag Heo
Yong Il Min
Publikationsdatum: 19.06.2020
Verlag: Springer US
Erschienen in: Cardiovascular Drugs and Therapy / Ausgabe 5/2020
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI: https://doi.org/10.1007/s10557-020-07026-5

Neu im Fachgebiet Kardiologie

19.04.2024 | Vorhofflimmern | Nachrichten

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Pralidoxime-Induced Potentiation of the Pressor Effect of Adrenaline and Hastened Successful Resuscitation by Pralidoxime in a Porcine Cardiac Arrest Model

Abstract

Purpose

Methods

Results

Conclusion

Neu im Fachgebiet Kardiologie

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Kardiologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2020

Tailoring Dual Antiplatelet Therapy for the Complex PCI Patient: Current Status and Perspectives

Diallyl Trisulfide Suppresses Angiotensin II–Induced Vascular Remodeling Via Inhibition of Mitochondrial Fission

Smooth Muscle Sirtuin 1 Blocks Thoracic Aortic Aneurysm/Dissection Development in Mice

Benefit-Risk Profile of DAPT Continuation Beyond 1 Year after PCI in Patients with High Thrombotic Risk Features as Endorsed by 2018 ESC/EACTS Myocardial Revascularization Guideline

Protection of Sacubitril/Valsartan against Pathological Cardiac Remodeling by Inhibiting the NLRP3 Inflammasome after Relief of Pressure Overload in Mice

Vasopressin in Patients with Septic Shock and Dynamic Left Ventricular Outflow Tract Obstruction

Neu im Fachgebiet Kardiologie

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Kardiologie