Key result
Intravenous protamine administration for heparin reversal resulted in acute non-cardiogenic pulmonary edema requiring VA-ECMO in a 62-year-old male.
Why the study?
To report and discuss the pathophysiology of protamine-related non-cardiogenic pulmonary edema compared to typical protamine reactions during heparin reversal.
Case Report (n=1)
This case highlights the risk of life-threatening non-cardiogenic pulmonary edema following protamine administration for heparin reversal during cardiac surgery.
Answers are grounded in this paper and cite their sources.
Suggests clinicians consider protamine-induced pulmonary edema in heparin reversal; extends case reports but leaves incidence and mechanisms open.
A 62-year-old male presented for coronary artery bypass graft (CABG) and aortic valve replacement (AVR). Following initiation of intravenous (IV) protamine for heparin reversal, the patient developed acute pulmonary edema characterized by reduced oxygen saturations and increasing airway pressures necessitating venoarterial extracorporeal membrane oxygenation (VA-ECMO) for lung recovery. This case report discusses the pathophysiology of protamine-related non-cardiogenic pulmonary edema (NCPE) and its comparison to typical protamine reactions. Anesthesiologists must be aware of this potentially life-threatening complication during procedures where protamine is commonly used to reverse the effects of heparin anticoagulation. Anesthesiology, Cardiac/Thoracic/Vascular Surgery
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Kim et al. (2025) conducted a case report in protamine-related non-cardiogenic pulmonary edema (n=1). Intravenous protamine was evaluated on acute pulmonary edema necessitating VA-ECMO. Intravenous protamine administration for heparin reversal resulted in acute non-cardiogenic pulmonary edema requiring VA-ECMO in a 62-year-old male.
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