[Cardiac arrest following protamine sulphate administration (author's transl)]

This study presents the case history of a patient who suffered from recurrent pulmonary embolism, despite heparinisation, after a car accident and who died during preparation for caval ligature. We feel that the protamine sulphate given for neutralization of the heparin effect played an important role, since no signs of massive pulmonary embolism were found at autopsy. Protamine sulphate is known to possess a significant cardiovascular depressive action. On the basis of a survey of the literature the possible potentiation of circulatory insufficiency by changed haemodynamics following pulmonary embolism, induction of anaesthesia, and protamine sulphate is discussed. Proposals for improved management of such case are made.