Life threatening cardiopulmonary failure in an infant following protamine reversal of heparin after cardiopulmonary bypass.
Life threatening cardiopulmonary failure following protamine reversal of heparin after cardiopulmonary bypass (CPB) was reported to occur in adults but rarely in children. Atrial septal defect closure was performed in a 6-week-old infant erroneously suspected to suffer from right atrial thrombosis in addition. Protamine administration after CPB led to critical pulmonary hypertension and severe haemorrhagic pulmonary oedema resulting in severe hypoxia. Inhaled nitric oxide, together with high frequency oscillation ventilation supplemented by intravenous prostacycline, enabled complete recovery of cardiopulmonary and neurological function. Life threatening cardiovascular compromise after intravenous protamine can occur even in young infants which then require challenging paediatric critical care.
Boigner
H
H
PICU, University Children's Hospital of Vienna, Vienna, Austria. harald.boigner@aon.at
Lechner
E
E
Brock
H
H
Golej
J
J
Trittenwein
G
G
D002315:Cardiopulmonary Bypass; D005260:Female; D006323:Heart Arrest / Q000209:etiology*; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006494:Heparin Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000139:chemically induced*; D011479:Protamines / Q000009:adverse effects* / Q000627:therapeutic use; D013902:Radiography, Thoracic
D006494:Heparin Antagonists; D011479:Protamines