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Hemodynamic effects of intraaortic versus intravenous protamine administration after cardiopulmonary bypass in man
E Ovrum1, H Lindberg, E A Holen
1Department of Surgery A, National Hospital, Rikshospitalet, Oslo, Norway.
Insights
Administering protamine intravenously during heart surgery causes faster hemodynamic changes than the aortic route. This suggests protamine
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Protamine sulfate is used to reverse heparin anticoagulation after cardiopulmonary bypass.
- The route of protamine administration may influence its hemodynamic side effects.
Purpose of the Study:
- To compare the hemodynamic effects of protamine administered via the ascending aorta versus the central venous line in patients undergoing coronary artery bypass surgery.
Main Methods:
- A hemodynamic study involving 32 male patients undergoing elective coronary artery bypass surgery.
- Patients were divided into two groups: Group A (intra-aortic protamine) and Group V (intravenous protamine).
- Hemodynamic profiles were continuously recorded after protamine infusion over 120 seconds.
Main Results:
- Systemic arterial pressure decreased significantly in both groups, with faster changes observed in the intravenous group (Group V).
- Pulmonary artery pressure, pulmonary capillary wedge pressure, and central venous pressure increased in both groups, with higher levels in Group V.
- Cardiovascular responses were significantly more rapid in the intravenous group.
Conclusions:
- The intravenous route of protamine administration leads to more rapid and pronounced hemodynamic changes compared to the intra-aortic route.
- The findings suggest that the lungs may be the primary site for initiating protamine's hemodynamic effects.
- Systemic hypotension during protamine administration is not mitigated by using the intra-aortic route over the intravenous route.
Abstract:
A hemodynamic study of men undergoing elective coronary artery bypass surgery was undertaken to elucidate the side effects of protamine given into the ascending aorta (group A, n = 16) or into the central venous line (group V, n = 16). After termination of extracorporeal circulation, protamine was infused over 120 seconds, and the hemodynamic profile was continuously recorded. During the first minute, the systemic arterial pressure fell to about 60% of the preprotamine level in both groups, but the hemodynamic changes occurred more rapidly (p < 0.05) in group V than in group A, with maximal pressure drop at 61.7 +/- 2.7 vs 74.4 +/- 4.9 seconds. Following spontaneous restoration of the systemic blood pressure, the pulmonary artery pressure rose considerably in both groups, as did the pulmonary capillary wedge and central venous pressures, reaching higher levels in the intravenous group. The cardiovascular responses were again more rapid in group V than in group A (p = 0.004). The degree of systemic hypotension thus did not benefit from use of the intraaortic rather than the intravenous route for administering protamine. The more pronounced and more rapid pulmonary circulatory changes in the intravenous group suggest that the hemodynamic effects of protamine are initiated in the lungs.
