title: Intraaortic administration of protamine: Method for heparin neutralization after cardiopulmonary bypass.
abstract: In neutralizing heparin with intravenous protamine sulfate, hypotension may be prevented by administering the drug intraarterially. Forty patients underwent cardiac surgery with extracorporeal circulation in our hospital; each received a rapid injection of nondiluted protamine sulfate in the aortic root to reverse the effects of heparin. To maintain the blood volume at a constant level, volume expanders and inotropic drugs were avoided. The intraaortic injections ranged in duration from 0.2 min to 2.8 min, with a mean of 1.1 min. The mean systolic pressure only dropped from 92 mm Hg (SD +/- 21) before protamine injection to 85 mm Hg (SD +/- 23) after injection (p < 0.0001). In seven patients (18%), no hypotension was evident; in the remaining patients, the systolic pressure returned to preinjection values within a mean of 2.2 min. Coagulation was observed within 3 to 4 min (mean = 2.2 min) after the initiation of injection. This study indicates that intraaortic administration of protamine is a rapid and safe technique for heparin reversal after cardiopulmonary bypass.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Aris
authors.forename: Heriberto
authors.initials: H
authors.lastname: Solanes
authors.forename: Jose O.
authors.initials: JO
authors.lastname: Bonnin
authors.forename: Rosa
authors.initials: R
authors.lastname: Garin
authors.forename: Jose M.
authors.initials: JM
authors.lastname: Caralps