Effects of the administration of 2,3-butanedione monoxime during conventional cardiopulmonary resuscitation on ischaemic contracture and resuscitability in a pig model of out-of-hospital cardiac arrest

Abstract Aim of the study Ischaemic contracture compromises the haemodynamic effectiveness of cardiopulmonary resuscitation and resuscitability. 2,3-Butanedione monoxime (BDM) reduced ischaemic contracture by inhibiting actin-myosin crossbridge formation in an isolated heart model. We investigated the effects of BDM on ischaemic contracture and resuscitation outcomes in a pig model of out-of-hospital cardiac arrest (OHCA). Methods After 15 min of untreated ventricular fibrillation, followed by 8 min of basic life support, 16 pigs were randomised to receive either 2 ml kg −1 of BDM solution (25 g l −1 ) or 2 ml kg −1 of saline during advanced cardiac life support (ACLS). Results During the ACLS, the control group showed an increase in left ventricular (LV) wall thickness from 10.0 mm (10.0–10.8) to 13.0 mm (13.0–13.0) and a decrease in LV chamber area from 8.13 cm 2 (7.59–9.29) to 7.47 cm 2 (5.84–8.43). In contrast, the BDM group showed a decrease in the LV wall thickness from 10 mm (9.0–10.8) to 8.5 mm (7.0–9.8) and an increase in the LV chamber area from 9.86 cm 2 (7.22–12.39) to 12.15 cm 2 (8.02–14.40). Mixed model analyses of the LV wall thickness and LV chamber area revealed significant group effects and group-time interactions. Spontaneous circulation was restored in four (50%) animals in the control group and in eight (100%) animals in the BDM group ( p  = 0.077). All the resuscitated animals survived during an intensive care period of 4 h. Conclusion BDM administered during cardiopulmonary resuscitation reversed ischaemic contracture in a pig model of OHCA.