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Gordon N. Olinger
Ronald M. Becker
Lawrence I. Bonchek
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Ann Thorac Surg 1980;29:20-25
© 1980 The Society of Thoracic Surgeons

Articles

Noncardiogenic Pulmonary Edema and Peripheral Vascular Collapse Following Cardiopulmonary Bypass: Rare Protamine Reaction?

Gordon N. Olinger, M.D.*, Ronald M. Becker, M.D., Lawrence I. Bonchek, M.D.

Department of Cardiothoracic Surgery, the Medical College of Wisconsin, Milwaukee, WI, and the Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, Bronx, NY

Accepted for publication March 15, 1979.

* Address reprint requests to Dr. Olinger, Associate Professor, Department of Cardiothoracic Surgery, The Medical College of Wisconsin, 8700 W Wisconsin Ave, Milwaukee, WI 53226

Four instances of severe anaphylactoid reaction occurring subsequent to cardiopulmonary bypass are described. These catastrophic reactions, from which 2 patients died, took place approximately an hour following administration of protamine and were characterized by marked peripheral vasodilatation, loss of capillary membrane integrity, and fulminant noncardiogenic pulmonary edema. Primary cardiac depression was not evident. We hypothesize that protamine was the causative agent in these unusually severe reactions. Differential diagnosis from other causes of acute cardiorespiratory dysfunction depended on early assessment of pulmonary artery and left ventricular filling pressures, cardiac output, respiratory mechanics, and arterial blood gases. Therapy was difficult; success in 1 of the patients seemed to have been effected in part by prompt administration of high-dose corticosteroids and maintenance of peripheral vascular tone with an alpha-adrenergic agonist.




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