diacetylmonoxime and Heart-Arrest

Ischemic contracture compromises the hemodynamic effectiveness of cardiopulmonary resuscitation (CPR) and resuscitability from cardiac arrest. In a pig model of cardiac arrest, 2,3-butanedione monoxime (BDM) attenuated ischemic contracture. We investigated the effects of different doses of BDM to determine whether increasing the dose of BDM could improve the hemodynamic effectiveness of CPR further, thus ultimately improving resuscitability.. After 16minutes of untreated ventricular fibrillation and 8minutes of basic life support, 36 pigs were divided randomly into 3 groups that received 50mg/kg (low-dose group) of BDM, 100mg/kg (high-dose group) of BDM, or an equivalent volume of saline (control group) during advanced cardiovascular life support.. During advanced cardiovascular life support, the control group showed an increase in left ventricular (LV) wall thickness and a decrease in LV chamber area. In contrast, the BDM-treated groups showed a decrease in the LV wall thickness and an increase in the LV chamber area in a dose-dependent fashion. Mixed-model analyses of the LV wall thickness and LV chamber area revealed significant group effects and group-time interactions. Central venous oxygen saturation at 3minutes after the drug administration was 21.6% (18.4-31.9), 39.2% (28.8-53.7), and 54.0% (47.5-69.4) in the control, low-dose, and high-dose groups, respectively (P<.001). Sustained restoration of spontaneous circulation was attained in 7 (58.3%), 10 (83.3%), and 12 animals (100%) in the control, low-dose, and high-dose groups, respectively (P=.046).. 2,3-Butanedione monoxime administered during CPR attenuated ischemic contracture and improved the resuscitability in a dose-dependent fashion.

Topics: Animals; Cardiopulmonary Resuscitation; Diacetyl; Disease Models, Animal; Dose-Response Relationship, Drug; Enzyme Inhibitors; Heart Arrest; Ischemic Contracture; Swine; Ventricular Fibrillation; Ventricular Function, Left

The coronary oxygen persufflation (COP) technique has been previously shown to allow prolonged heart preservation of 14 hr with optimal recovery in a pig model of orthotopic transplantation. This technique may be applicable to hearts grafted from non-heart-beating donors (NHBD).. Experiments were performed on pigs to test the effectiveness of oxygenated preservation, using COP for preservation of NHBD hearts. After 16 min of in situ normothermic ischemia, the hearts were flushed with histidine-tryptophan-ketoglutarate (HTK) solution or modified HTK solution (mBHTK) including 30 mmol/L 2,3-butanedione monoxime, 40 mg/L hyaluronidase,15 micromol/L adenosine, and 50 micromol/L calcium. Hearts were stored in the flush solutions for 3.3 hr or additionally persufflated with gaseous oxygen through the coronary arteries (COP) and transplanted orthotopically.. Simple storage in HTK did not allow recovery of these hearts, whereas mBHTK storage resulted in improved function with 1.1 L/min cardiac output. The cardiac output reached 2.8 L/min (68% of normal values) with a left ventricular developed pressure of 101 mm Hg only after mBHTK+COP. Then the hearts were able to guarantee the circulation of the recipient for the test period after weaning from the heart-lung machine.. Even in an NHBD with more than 15 min of in situ ischemia, the use of COP in combination with mBHTK solution for 3.3-hr storage of the heart allows excellent recovery of transplanted hearts and normal weaning from the heart-lung machine. This indicates that COP combined with mBHTK may be an optimal preservation technique for use with NHBD hearts.

Topics: Animals; Diacetyl; Glucose; Heart Arrest; Heart Transplantation; Heart-Lung Machine; Hypothermia, Induced; Mannitol; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Organ Preservation Solutions; Oxygen; Potassium Chloride; Procaine; Swine; Tissue Preservation

Effects of 2,3-butanedione monoxime (BDM), an ATPase inhibitor, on ischemia-reperfusion myocardial injury were examined in isolated working rat hearts perfused in vitro. Following cardiac arrest induced by cardioplegic solution, global ischemia was produced for 30 min. In untreated hearts, reperfusion for 45 min resulted in an incomplete recovery of cardiac pump function. When BDM was added to the cardioplegic solution up to 20 mM, the recovery of cardiac function was significantly improved average by 19%. This BDM effect can, presumably, reduce ATP losses during ischemia and like that improve recovery of cardiac function during reperfusion.

Topics: Adenosine Triphosphatases; Animals; Cardioplegic Solutions; Diacetyl; Heart Arrest; In Vitro Techniques; Myocardial Reperfusion Injury; Rats