Evaluation of Hemodynamic Changes Due to Protamine Administration by Calcium Gluconate after Coronary Artery Bypass Grafting Surgery

Background: Administration of Protamine sulfate for heparin neutralization after cardiopulmonary bypass may
be associated with adverse reactions such as transient hypotension to cardiovascular collapse. Although catastrophic
events are rare and occur only in 2.6% of cardiac surgeries, it is associated with adverse postoperative
outcome. The aim of this study is to investigate whether bolus administration of calcium gluconate can minimize
the adverse hemodynamic effects of protamine.
Patients and Methods: This randomized clinical trial (RCT) prospective study was conducted between Feb.
2006 to Dec. 2008. The patients were randomly allocated into three groups including group A (42 patients) who
received only protamine after weaning from cardiopulmonary, group B (44 patients) concomitantly treated with
protamine sulfate and calcium gluconate, and group C (40 patients) receiving calcium gluconate 5 minutes before
administration of protamine. Hemodynamic variables such as systolic and diastolic blood pressures, mean
of arterial pressure, central venous pressure and heart rate were obtained 0, 2, 4, 6, 8 and 10 minutes after
protamine administration from each group.
Results: Systolic blood pressure in groups A (control) and C (calcium administration before protamine) 0,2,4,6,8
and 10 minutes after protamine administration initially decreased and increased subsequently (P=0.228). Also no
statistically significant difference was found in diastolic blood pressure (DBP), mean arterial pressure (MAP),
central venous pressure (CVP), and heart rate (HR) in 0,2,4,6,8, and 10 minutes in any of the three groups.
Conclusion: In our study, hemodynamic changes in 10 minutes after protamine administration for heparin neutralization
in patients with good left ventricular systolic function after coronary artery bypass grafting surgery
were mild, and prophylactic calcium gluconate administration concurrent with or before protamine injection
was not recommended.