J Korean Soc Emerg Med.  2023 Dec;34(6):498-504.

Association between pralidoxime administration during cardiopulmonary resuscitation and brain tissue oxygen tension in a swine model of cardiac arrest

• Ko SW
• Min YI
• Jeung KW
• Lee HY
• Jung YH
• Lee BK
• Lee DH
• Heo T

Abstract

Objective
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.
Methods
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.
Results
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.
Conclusion
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.

Keyword

Pralidoxime; Epinephrine; Cardiopulmonary resuscitation