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European Journal of Cardio-Thoracic Surgery, Vol 10, 463-466, Copyright © 1996 by European Association for Cardio-thoracic Surgery

ARTICLES

Protamine-induced fulminating non-cardiogenic pulmonary edema following cardiopulmonary bypass

C Kindler, A Bircher and P Stulz
Department of Anesthesia, University of Basel, Kantonsspital, Switzerland.

Although fulminating non-cardiogenic pulmonary edema following cardiopulmonary bypass is not a new phenomenon, the exact cause and pathogenesis are still unknown. The causative agent of this potentially lethal syndrome was hypothesized to be either protamine or blood products. There was no evidence that an antibody-mediated reaction plays a role and patients were reported to have negative skin tests. We report, for the first time, a patient who presented with fulminating non-cardiogenic pulmonary edema after repeated protamine administration with a subsequent positive skin test to protamine. Specific IgG antibodies to protamine were also found; however, the level was in the range of that of exposed non-reacting controls. IgE antibodies could not be detected.


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Copyright © 1996 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.