Protamine Administration Via the Ascending Aorta May Prevent Cardiopulmonary Instability

Objective The method of protamine administration may influence adverse reactions. The authors investigated the effects of 3 different methods of protamine administration on cardiopulmonary function. Design Prospective, randomized clinical study. Setting Single university hospital. Participants Human...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2016-06, Vol.30 (3), p.647-655
Main Authors: Chaney, Mark A., MD, Devin Roberts, J., MD, Wroblewski, Kristen, MS, Shahul, Sajid, MD, MPH, Gaudet, Ross, MD, Jeevanandam, Valuvan, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia & Perioperative Care
anticoagulation
Aorta
aortic administration
Cardiac Surgical Procedures - adverse effects
Cardiopulmonary Bypass
Critical Care
Female
Hemodynamics - drug effects
heparin
Humans
Male
Middle Aged
Oxygen - blood
potamine
Prospective Studies
Protamines - administration & dosage
reversal
venous administration
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Summary:Objective The method of protamine administration may influence adverse reactions. The authors investigated the effects of 3 different methods of protamine administration on cardiopulmonary function. Design Prospective, randomized clinical study. Setting Single university hospital. Participants Human volunteer patients. Interventions Ninety-five patients undergoing cardiac surgery were randomized prospectively into 3 groups. Group central vein control (CVC) and group central vein (CV) received protamine via a central vein over 10 minutes and 2 minutes, respectively. Group ascending aorta (AA) received protamine via the ascending aorta over 2 minutes. Hemodynamic parameters were assessed at 7 intraoperative time points, and pulmonary parameters were assessed at 4 intraoperative time points. Measurements and Main Results The groups were similar regarding preoperative demographics, intraoperative care, and baseline cardiopulmonary function. However, both the CVC and CV groups exhibited decreased blood pressure and impaired pulmonary oxygenation after protamine administration; these changes were not observed in the AA group. Within-group changes in mean arterial blood pressure after protamine administration were significant in the AA group (mean increase 6.5 mmHg; p = 0.01) but not in the CVC (mean decrease 3.1 mmHg, p = 0.13) or CV (mean decrease 4.3 mmHg, p = 0.14) groups. Within-group changes in arterial oxygenation after protamine administration were significant in the CVC (mean decrease 85 mmHg; p
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2015.11.014