Anaes Vivas · Cardiac anaesthesia
Heparin, protamine, and coagulopathy on CPB — viva
Structured oral examination station for protamine-heparin-coagulopathy-cpb.
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ANZCAFRCAEDAICABAFCAI
Prompt
Cardiac theatre stem focusing on heparin, protamine, and coagulopathy on cpb with a monitoring printout and TOE still available.
Opening
One-line answer: Weight-based heparin bolus to ACT ≥480 s before CPB; reverse with protamine about 1 mg per 100 IU heparin given slowly; treat protamine reactions by stopping the drug and supporting the RV and SVR while diagnosing residual heparin vs surgical bleeding with ACT and viscoelastic tests.
[3] [4] [5]References5ShowHide
- [1]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. N Engl J Med, 2017.PMID 29130845
- [2]Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr, 2013.PMID 23998692
- [3]Levy JH, Ghadimi K, Kizhakkedathu JN, et al. What's fishy about protamine? Clinical use, adverse reactions, and potential alternatives. J Thromb Haemost, 2023.PMID 37062523
- [4]Levy JH, Sniecinski RM, Maier CL, et al. Finding a common definition of heparin resistance in adult cardiac surgery: communication from the ISTH SSC subcommittee on perioperative and critical care thrombosis and hemostasis. J Thromb Haemost, 2024.PMID 38215912
- [5]Agarwal S, Abdelmotieleb M Viscoelastic testing in cardiac surgery. Transfusion, 2020.PMID 32955756