Cardiopulmonary bypass

Question 1

Therapeutic anticoagulation dose

Answer 1

300-450 IU/kg of IV heparin

Question 2

Activated clotting time (ACT). Target?

Answer 2

Standard measure of the adequacy of anticoagulation
Does NOT reflect heparin present in the blood; influenced by hemodilution and hypothermia

Target >480 seconds

Question 3

Heparin resistance

Answer 3

Antithrombin III (ATIII) deficiency

Question 4

Antithrombin III (ATIII) deficiency

Answer 4

• More commonly acquired; results from recent heparin administration or protein-losing enteropathy
• May be inherited (autosomal dominant pattern)

Question 5

Rx for antithrombin III def

Answer 5

• Give additional heparin

- If target ACT not achieved after 600 IU/kg of heparin, give recombinant antithrombin III. If not available, give FFP.

Question 6

Protamine reaction type I

Answer 6

histamine release –> hypotension

Question 7

Protamine reaction type IIA

Answer 7

True anaphylactic (IgE, IgG mediated)

Question 8

Protamine reaction type IIB

Answer 8

Immediate/early anaphylactoid response

Question 9

Protamine reaction type IIC

Answer 9

Delayed non-cardiogenic pulmonary edema

Question 10

Protamine reaction type III

Answer 10

Catastrophic pulmonary hypertension –> RV failure –> severe hypotension

Question 11

Protamine procoagulant effect and dose

Answer 11

Reverses heparin by non-specific acid/base interaction
Polypetide composed of 70% arginine
Dose: 1 mg /100 units
No effect on Lovenox