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anybody else have a surgeon who does this when off pump?
anybody else have a surgeon who does this when off pump?
anybody else have a surgeon who does this when off pump?
Yes. Works ok. I see more hypotension just because they give it in a few seconds. Pressure comes back quickly.
nopeDo they still test dose the Protamine?
yep, the bp crashes pretty much every time. i pick up the calcium every time he does it b/c its inevitable. he's been doing it for years, and it's only to speed things up. i do have to say, he's a bad-ass, like a ninja with a scalpel, so i dont make a big deal about it
Your surgeon likely didn't notice that the perfusioninst at the other institution gave 1 liter from the reservoir as the protamine went in.I'm going to bump this thread, as one of my cardiac surgeons just came back to us after spending a few weeks at another facility where they gave protamine via a 20-ga butterfly in the aorta coming off pump. She was so excited to try it with us, as it's "faster" (1 min vs 5-10 minutes), and she said it didn't cause hypotension. Well, I gave her my usual reversal dose, she injected it into the aorta, and the pressure plummeted from 110s to 30s within seconds. I responded during the nosedive with calcium, norepi, and epi, and the pressure rebounded rapidly. The second case we tried this, I gave calcium as she pushed protamine, and the pressure still tanked, but not quite as severely (only to the 50s). She swears it never did that at the other hospital. For those of you who do this, do you adjust your protamine dose, as you're bypassing first-pass in the lungs? Do you just give more calcium before and during the injection? Our other two surgeons seemed rather nonplussed about the idea, so hopefully, this will fade away and no longer be an issue. However, in the event that she wants to keep at it, any pointers from the group would be welcome.
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Why would it be faster than bolusing it through the central line?I'm going to bump this thread, as one of my cardiac surgeons just came back to us after spending a few weeks at another facility where they gave protamine via a 20-ga butterfly in the aorta coming off pump. She was so excited to try it with us, as it's "faster" (1 min vs 5-10 minutes), and she said it didn't cause hypotension. Well, I gave her my usual reversal dose, she injected it into the aorta, and the pressure plummeted from 110s to 30s within seconds. I responded during the nosedive with calcium, norepi, and epi, and the pressure rebounded rapidly. The second case we tried this, I gave calcium as she pushed protamine, and the pressure still tanked, but not quite as severely (only to the 50s). She swears it never did that at the other hospital. For those of you who do this, do you adjust your protamine dose, as you're bypassing first-pass in the lungs? Do you just give more calcium before and during the injection? Our other two surgeons seemed rather nonplussed about the idea, so hopefully, this will fade away and no longer be an issue. However, in the event that she wants to keep at it, any pointers from the group would be welcome.
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Negative.
But we've had TWO full blown crash back on pump/ECMO protamine reactions in the last month. Craziness.
This is a good point for residents to be aware for boards.Absolutely both times.
First patient was on insulin (maybe NPH in past?) and second had a vasectomy.
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