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Lee HY, Jung YH, Mamadjonov N, Jeung KW, Kim MC, Lim KS, Jeon CY, Lee Y, Kim HJ. Effects of Sodium Nitroprusside Administered Via a Subdural Intracranial Catheter on the Microcirculation, Oxygenation, and Electrocortical Activity of the Cerebral Cortex in a Pig Cardiac Arrest Model. J Am Heart Assoc 2022; 11:e025400. [PMID: 35624079 PMCID: PMC9238727 DOI: 10.1161/jaha.122.025400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Postischemic cerebral hypoperfusion has been indicated as an important contributing factor to secondary cerebral injury after cardiac arrest. We evaluated the effects of sodium nitroprusside administered via a subdural intracranial catheter on the microcirculation, oxygenation, and electrocortical activity of the cerebral cortex in the early postresuscitation period using a pig model of cardiac arrest. Methods and Results Twenty‐nine pigs were resuscitated with closed cardiopulmonary resuscitation after 14 minutes of untreated ventricular fibrillation. Thirty minutes after restoration of spontaneous circulation, 24 pigs randomly received either 4 mg of sodium nitroprusside (IT‐SNP group) or saline placebo (IT‐saline group) via subdural intracranial catheters and were observed for 5 hours. The same dose of sodium nitroprusside was administered intravenously in another 5 pigs. Compared with the IT‐saline group, the IT‐SNP group had larger areas under the curve for tissue oxygen tension and percent changes of arteriole diameter and number of perfused microvessels from baseline (all P<0.05) monitored on the cerebral cortex during the 5‐hour period, without severe hemodynamic instability. This group also showed faster recovery of electrocortical activity measured using amplitude‐integrated electroencephalography. Repeated‐measures analysis of variance revealed significant group–time interactions for these parameters. Intravenously administered sodium nitroprusside caused profound hypotension but did not appear to increase the cerebral parameters. Conclusions Sodium nitroprusside administered via a subdural intracranial catheter increased post–restoration of spontaneous circulation cerebral cortical microcirculation and oxygenation and hastened electrocortical activity recovery in a pig model of cardiac arrest. Further studies are required to determine its impact on the long‐term neurologic outcomes.
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Affiliation(s)
- Hyoung Youn Lee
- Trauma Center Chonnam National University Hospital Gwangju Republic of Korea
| | - Yong Hun Jung
- Department of Emergency Medicine Chonnam National University Hospital Gwangju Republic of Korea.,Department of Emergency Medicine Chonnam National University Medical School Gwangju Republic of Korea
| | - Najmiddin Mamadjonov
- Department of Medical Science Chonnam National University Graduate School Gwangju Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine Chonnam National University Hospital Gwangju Republic of Korea.,Department of Emergency Medicine Chonnam National University Medical School Gwangju Republic of Korea
| | - Min Chul Kim
- Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Republic of Korea
| | - Kyung Seob Lim
- Futuristic Animal Resource & Research Center Korea Research Institute of Bioscience and Biotechnology Ochang Republic of Korea
| | - Chang-Yeop Jeon
- National Primate Research CenterKorea Research Institute of Bioscience and Biotechnology Ochang Republic of Korea
| | - Youngjeon Lee
- National Primate Research CenterKorea Research Institute of Bioscience and Biotechnology Ochang Republic of Korea
| | - Hyung Joong Kim
- Medical Science Research InstituteKyung Hee University Hospital Seoul Republic of Korea
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Lee HY, Shamsiev K, Mamadjonov N, Jung YH, Jeung KW, Kim JW, Heo T, Min YI. Effect of Epinephrine Administered during Cardiopulmonary Resuscitation on Cerebral Oxygenation after Restoration of Spontaneous Circulation in a Swine Model with a Clinically Relevant Duration of Untreated Cardiac Arrest. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5896. [PMID: 34072754 PMCID: PMC8198967 DOI: 10.3390/ijerph18115896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 01/13/2023]
Abstract
Severe neurological impairment was more prevalent in cardiac arrest survivors who were administered epinephrine than in those administered placebo in a randomized clinical trial; short-term reduction of brain tissue O2 tension (PbtO2) after epinephrine administration in swine following a short duration of untreated cardiac arrest has also been reported. We investigated the effects of epinephrine administered during cardiopulmonary resuscitation (CPR) on cerebral oxygenation after restoration of spontaneous circulation (ROSC) in a swine model with a clinically relevant duration of untreated cardiac arrest. After 7 min of ventricular fibrillation, 24 pigs randomly received either epinephrine or saline placebo during CPR. Parietal cortex measurements during 60-min post-resuscitation period showed that the area under the curve (AUC) for PbtO2 was smaller in the epinephrine group than in the placebo group during the initial 10-min period and subsequent 50-min period (both p < 0.05). The AUC for number of perfused cerebral capillaries was smaller in the epinephrine group during the initial 10-min period (p = 0.005), but not during the subsequent 50-min period. In conclusion, epinephrine administered during CPR reduced PbtO2 for longer than 10 min following ROSC in a swine model with a clinically relevant duration of untreated cardiac arrest.
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Affiliation(s)
- Hyoung Youn Lee
- Trauma Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea;
| | - Kamoljon Shamsiev
- Department of Medical Science, Chonnam National University Graduate School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea; (K.S.); (N.M.)
| | - Najmiddin Mamadjonov
- Department of Medical Science, Chonnam National University Graduate School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea; (K.S.); (N.M.)
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea; (Y.H.J.); (T.H.); (Y.I.M.)
- Department of Emergency Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea; (Y.H.J.); (T.H.); (Y.I.M.)
- Department of Emergency Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
| | - Tag Heo
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea; (Y.H.J.); (T.H.); (Y.I.M.)
- Department of Emergency Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea
| | - Yong Il Min
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea; (Y.H.J.); (T.H.); (Y.I.M.)
- Department of Emergency Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea
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Pralidoxime improves the hemodynamics and survival of rats with peritonitis-induced sepsis. PLoS One 2021; 16:e0249794. [PMID: 33822820 PMCID: PMC8023460 DOI: 10.1371/journal.pone.0249794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/22/2021] [Indexed: 12/29/2022] Open
Abstract
Several studies have suggested that sympathetic overstimulation causes deleterious effects in septic shock. A previous study suggested that pralidoxime exerted a pressor effect through a mechanism unrelated to the sympathetic nervous system; this effect was buffered by the vasodepressor action of pralidoxime mediated through sympathoinhibition. In this study, we explored the effects of pralidoxime on hemodynamics and survival in rats with peritonitis-induced sepsis. This study consisted of two sub-studies: survival and hemodynamic studies. In the survival study, 66 rats, which survived for 10 hours after cecal ligation and puncture (CLP), randomly received saline placebo, pralidoxime, or norepinephrine treatment and were monitored for up to 24 hours. In the hemodynamic study, 44 rats were randomly assigned to sham, CLP-saline placebo, CLP-pralidoxime, or CLP-norepinephrine groups, and hemodynamic measurements were performed using a conductance catheter placed in the left ventricle. In the survival study, 6 (27.2%), 15 (68.1%), and 5 (22.7%) animals survived the entire 24-hour monitoring period in the saline, pralidoxime, and norepinephrine groups, respectively (log-rank test P = 0.006). In the hemodynamic study, pralidoxime but not norepinephrine increased end-diastolic volume (P <0.001), stroke volume (P = 0.002), cardiac output (P = 0.003), mean arterial pressure (P = 0.041), and stroke work (P <0.001). The pressor effect of norepinephrine was short-lived, such that by 60 minutes after the initiation of norepinephrine infusion, it no longer had any significant effect on mean arterial pressure. In addition, norepinephrine significantly increased heart rate (P <0.001) and the ratio of arterial elastance to ventricular end-systolic elastance (P = 0.010), but pralidoxime did not. In conclusion, pralidoxime improved the hemodynamics and 24-hour survival rate in rats with peritonitis-induced sepsis, but norepinephrine did not.
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Lee HY, Mamadjonov N, Jeung KW, Jung YH, Lee BK, Moon KS, Heo T, Min YI. Pralidoxime-Induced Potentiation of the Pressor Effect of Adrenaline and Hastened Successful Resuscitation by Pralidoxime in a Porcine Cardiac Arrest Model. Cardiovasc Drugs Ther 2020; 34:619-628. [PMID: 32562104 DOI: 10.1007/s10557-020-07026-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
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.
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Affiliation(s)
- Hyoung Youn Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Najmiddin Mamadjonov
- Department of Medical Science, Chonnam National University Graduate School, Gwangju, Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea. .,Department of Emergency Medicine, Chonnam National Univeristy Medical School, Gwangju, Republic of Korea.
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National Univeristy Medical School, Gwangju, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National Univeristy Medical School, Gwangju, Republic of Korea
| | - Kyung-Sub Moon
- Department of Emergency Medicine, Chonnam National Univeristy Medical School, Gwangju, Republic of Korea.,Department of Neurosurgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Tag Heo
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National Univeristy Medical School, Gwangju, Republic of Korea
| | - Yong Il Min
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National Univeristy Medical School, Gwangju, Republic of Korea
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Jung YH, Mamadjonov N, Lee HY, Jeung KW, Lee BK, Youn CS, Heo T, Min YI. 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. [PMID: 32070203 PMCID: PMC7335542 DOI: 10.1161/jaha.119.015076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background We previously reported that pralidoxime facilitated restoration of spontaneous circulation by potentiating the pressor effect of epinephrine. We determined the optimal dose of pralidoxime during cardiopulmonary resuscitation and evaluated the involvement of α‐adrenoceptors in its pressor action. Methods and Results Forty‐four pigs randomly received 1 of 3 doses of pralidoxime (40, 80, or 120 mg/kg) or saline placebo during cardiopulmonary resuscitation, including epinephrine administration. Pralidoxime at 40 mg/kg produced the highest coronary perfusion pressure, whereas 120 mg/kg of pralidoxime produced the lowest coronary perfusion pressure. Restoration of spontaneous circulation was attained in 4 (36.4%), 11 (100%), 9 (81.8%), and 3 (27.3%) animals in the saline, 40, 80, and 120 mg/kg groups, respectively (P<0.001). In 49 rats, arterial pressure response to 40 mg/kg of pralidoxime was determined after saline, guanethidine, phenoxybenzamine, or phentolamine pretreatment, and the response to 200 mg/kg pf pralidoxime was determined after saline, propranolol, or phentolamine pretreatment. Pralidoxime at 40 mg/kg elicited a pressor response. Phenoxybenzamine completely inhibited the pressor response, but guanethidine and phentolamine did not. The pressor response of pralidoxime was even greater after guanethidine or phentolamine pretreatment. Pralidoxime at 200 mg/kg produced an initial vasodepressor response followed by a delayed pressor response. Unlike propranolol, phentolamine eliminated the initial vasodepressor response. Conclusions Pralidoxime at 40 mg/kg administered with epinephrine improved restoration of spontaneous circulation rate by increasing coronary perfusion pressure in a pig model of cardiac arrest, whereas 120 mg/kg did not improve coronary perfusion pressure or restoration of spontaneous circulation rate. The pressor effect of pralidoxime was unrelated to α‐adrenoceptors and buffered by its vasodepressor action mediated by sympathoinhibition.
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Affiliation(s)
- Yong Hun Jung
- Department of Emergency Medicine Chonnam National University Hospital Gwangju Republic of Korea.,Department of Emergency Medicine Chonnam National University Medical School Gwangju Republic of Korea
| | - Najmiddin Mamadjonov
- Department of Medical Science Chonnam National University Graduate School Gwangju Republic of Korea
| | - Hyoung Youn Lee
- Department of Emergency Medicine Chonnam National University Hospital Gwangju Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine Chonnam National University Hospital Gwangju Republic of Korea.,Department of Emergency Medicine Chonnam National University Medical School Gwangju Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine Chonnam National University Hospital Gwangju Republic of Korea.,Department of Emergency Medicine Chonnam National University Medical School Gwangju Republic of Korea
| | - Chun Song Youn
- Department of Emergency Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Tag Heo
- Department of Emergency Medicine Chonnam National University Hospital Gwangju Republic of Korea.,Department of Emergency Medicine Chonnam National University Medical School Gwangju Republic of Korea
| | - Yong Il Min
- Department of Emergency Medicine Chonnam National University Hospital Gwangju Republic of Korea.,Department of Emergency Medicine Chonnam National University Medical School Gwangju Republic of Korea
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Jung YH, Lee HY, Jeung KW, Lee BK, Youn CS, Yun SW, Heo T, Min YI. Pralidoxime administered during cardiopulmonary resuscitation facilitates successful resuscitation in a pig model of cardiac arrest. Clin Exp Pharmacol Physiol 2020; 47:236-246. [PMID: 31631356 DOI: 10.1111/1440-1681.13198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/24/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
Pralidoxime is a common antidote for organophosphate poisoning; however, studies have also reported pralidoxime's pressor effect, which may facilitate the restoration of spontaneous circulation (ROSC) after cardiac arrest by improving coronary perfusion pressure (CPP). We investigated the immediate cardiovascular effects of pralidoxime in anaesthetised normal rats and the effects of pralidoxime administration during cardiopulmonary resuscitation (CPR) in a pig model of cardiac arrest. To evaluate the immediate cardiovascular effects of pralidoxime, seven anaesthetised normal rats received saline or pralidoxime (20 mg/kg) in a randomised crossover design, and the responses were determined using the conductance catheter technique. To evaluate the effects of pralidoxime administration during CPR, 22 pigs randomly received either 80 mg/kg of pralidoxime or an equivalent volume of saline during CPR. In the rats, pralidoxime significantly increased arterial pressure than saline (P = .044). The peak effect on arterial pressure was observed in the first minute. In a pig model of cardiac arrest, CPP during CPR was higher in the pralidoxime group than in the control group (P = .002). ROSC was attained in three animals (27.3%) in the control group and nine animals (81.8%) in the pralidoxime group (P = .010). Three animals (27.3%) in the control group and eight animals (72.2%) in the pralidoxime group survived the 6-hour period (P = .033). In conclusion, pralidoxime had a rapid onset of pressor effect. Pralidoxime administered during CPR led to significantly higher rates of ROSC and 6-hour survival by improving CPP in a pig model.
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Affiliation(s)
- Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyoung Youn Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chun Song Youn
- Department of Emergency Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Seong Woo Yun
- Department of Emergency Medical Technology, Namseoul University, Cheonan, Korea
| | - Tag Heo
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Il Min
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
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