The Annals of Thoracic Surgery, Vol 29, 15-19, Copyright © 1980 by The Society of Thoracic Surgeons
Bradykinin, plasma protein fraction, and hypotension
N Ellison, M Behar, H MacVaugh 3d and BE Marshall
A directive from the Food and Drug Administration indicates that the use of
plasma protein fraction (PPF) is contraindicated during cardiopulmonary
bypass because of possible hypotension. Bradykinin has been implicated as
the cause of this hypotension. Bradykinin levels were measured by
radioimmunoassay in PPF and in 5% albumin and were found to be consistently
elevated in the former and occasionally in the latter. The addition of PPF
to pump primes resulted in significantly elevated levels of bradykinin,
which rapidly cleared, indicating that extrapulmonary sites of bradykinin
inactivation were efficient. The potential hypotensive effect of PPF was
observed by determining the change in mean perfusion pressure in two groups
of patients: one group with a 3,000 ml crystalloid prime and the other with
a prime of 2,000 ml of crystalloid and 1,000 ml of PPF. There was no
significant difference in the perfusion pressure between the two groups at
any point, and the hypotensive effects seen in both groups were readily
treated, suggesting that the directive against the use of PPF during
cardiopulmonary bypass may be unnecessarily restrictive.
