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J Korean Soc Emerg Med > Volume 34(6); 2023 > Article
Journal of The Korean Society of Emergency Medicine 2023;34(6): 498-504.
Association between pralidoxime administration during cardiopulmonary resuscitation and brain tissue oxygen tension in a swine model of cardiac arrest
Sang Won Ko1 , Young Il Min1,2 , Kyung Woon Jeung1,2 , Hyoung Youn Lee1,2 , Yong Hun Jung1,2 , Byung Kook Lee1,2 , Dong Hun Lee1 , Tag Heo1,2
1Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
2Department of Emergency Medicine, Chonnam National University School of Medicine, Gwangju, Korea
Correspondence  Young Il Min ,Tel: 062-220-6809, Fax: 062-228-7417, Email: minyi46@daum.net,
Received: October 16, 2022; Revised: November 3, 2022   Accepted: November 3, 2022.  Published online: December 31, 2023.
Previous studies have suggested that epinephrine reduces brain tissue O2 tension (PbtO2) after the return of spontaneous circulation (ROSC) via α1-adrenoceptor stimulation and that pralidoxime had α1-adrenoceptor inhibitory action together with non-adrenergic vasopressor action. We sought to investigate the effects of pralidoxime administered during cardiopulmonary resuscitation (CPR) as a sole vasopressor on PbtO2 after ROSC. We hypothesized that pralidoxime administration would lead to a comparable ROSC rate and a higher PbtO2 after ROSC when compared to epinephrine administration.
After 7 minutes of ventricular fibrillation, 24 pigs randomly received either pralidoxime or epinephrine during CPR. Cerebral measurements, including PbtO2, were measured from the parietal cortices during the 60-minute postROSC period.
Coronary perfusion pressure (CPP) during CPR was significantly higher in the epinephrine group than in the pralidoxime group (P=0.012). All the animals in the epinephrine group achieved ROSC, while seven (58.3%) did so in the pralidoxime group (P=0.037). The area under the curves for PbtO2 during the post-ROSC period did not differ between the two groups.
Pralidoxime alone was significantly inferior to epinephrine in increasing CPP and achieving ROSC. In addition, pralidoxime administration did not improve PbtO2 during the post-resuscitation period as compared with epinephrine.
Key words: Pralidoxime; Epinephrine; Cardiopulmonary resuscitation
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