Anaes Cases · Cardiac anaesthesia & cardiopulmonary bypass
The protamine reaction
The short case — the protamine reaction (the pulmonary hypertension, the systemic hypotension, the RV failure from the heparin-protamine complex). The stop-the-protamine, the pulmonary-vasodilator, the inotropes, the vasopressors, the re-heparinisation-if-the-re-bypass.
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Prompt
After the protamine administration, the patient develops the sudden pulmonary hypertension, the hypotension, and the RV failure. Diagnose and manage.
Presentation
After the gradual protamine administration for the heparin reversal, the systemic blood pressure drops from 110 to 60 mmHg, the PA pressure rises from 25 to 55 mmHg, the TEE shows the dilated RV with the septal shift. The oxygen saturation is 95 per cent. Diagnose and manage.[37062524]
References2ShowHide
- [3]Levy JH, et al. What's fishy about protamine? J Thromb Haemost, 2023.PMID 37062523
- [37062524]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.