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The Hemodynamic Effects of Protamine in Pediatric Patients Undergoing Pulmonary Artery Reconstruction and
Xi Li1, Zhe Amy Fang2, M Michael Andrew Lennig1
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA; Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA.
Insights
Protamine administration slightly increased pulmonary artery pressures (PAPs) in pediatric patients after heart surgery. Co-administration with calcium did not further elevate PAPs.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Anesthesiology
Background:
- Pulmonary artery reconstruction and unifocalization are complex pediatric cardiac surgeries.
- Protamine is used to reverse heparin anticoagulation after cardiopulmonary bypass.
- The effect of protamine on pulmonary artery pressures (PAPs) in this specific surgical context requires investigation.
Purpose of the Study:
- To determine if protamine administration increases PAPs in patients undergoing unifocalization or pulmonary artery reconstruction.
- To assess the impact of calcium co-administration on protamine-induced changes in PAPs.
Main Methods:
- Retrospective database study at a pediatric heart center.
- Included patients undergoing pulmonary artery reconstruction or unifocalization.
- Analyzed changes in PAPs following protamine administration, with and without calcium, using data from Stanford University's repository.
Main Results:
- Protamine administration resulted in a statistically significant increase in PAPs post-cardiopulmonary bypass.
- PAPs were significantly higher at 2, 5, and 10 minutes after protamine bolus compared to baseline.
- Coadministration with calcium also increased PAPs, but did not result in a greater increase than protamine alone.
Conclusions:
- Protamine administration causes a modest increase in PAPs in pediatric patients undergoing complex cardiac surgeries.
- Calcium co-administration does not potentiate the increase in PAPs induced by protamine in this population.
Objectives:
To determine protamine administration increases pulmonary artery pressures (PAPs) in patients undergoing unifocalization or pulmonary artery reconstruction surgeries.
Design:
Retrospective database study.
Setting:
A large pediatric heart center within an academic quaternary care facility.
Participants:
All patients undergoing pulmonary artery reconstruction or a unifocalization procedure identifiable within the data warehouse.
Interventions:
We collected data from Stanford University's data repository, formatted it, and analyzed it using RStudio (v 2023.06.1+524).
Measurements And Main Results:
Our primary outcome is the change in PAP after the administration of protamine. Secondary outcomes include changes in the mean arterial pressure, the ratio of systolic pulmonary artery to systemic artery pressure, right-sided filling pressure, and left atrial pressure. After a protamine bolus, we found a difference in PAP (Friedman χ2 = 49.46; p < 0.001). When compared with 2 minutes before its administration, the PAP was higher at 2 minutes (29.00 mmHg versus 25.00 mmHg; p < 0.001), 5 minutes (30.00 mmHg versus 25.00 mmHg; p < 0.001) and 10 minutes (31 mmHg versus 25 mmHg; p < 0.001). When coadministered with calcium, there was also a significant increase in PAP (Friedman χ2 = 28.11; p < 0.001), with a higher PAP 10 minutes after calcium administration when compared with 2 minutes before (32 mmHg versus 26 mmHg; p < 0.001).
Conclusions:
Protamine administration led to a small increase in PAP after separation from cardiopulmonary bypass in patients undergoing pulmonary artery reconstruction or unifocalization surgeries. Calcium coadministration did not lead to a greater increase in PAP.
