Administration of Protamine Through Radial Arterial Access: A Prospective Observational Study

Protamine is mainly used to reverse the anticoagulant effect of heparin after cardiopulmonary bypass (CPB). Unfortunately, it is associated with adverse clinical reactions ranging from minor cardiopulmonary instability to fatal cardiovascular collapse. In the present prospective observational study, effects of protamine administration through peripheral intra-arterial route, i.e., radial artery, were investigated.

Despite the study limitations, the authors found that protamine administration through radial artery route can effectively neutralize heparin without any significant coagulopathy and postoperative bleeding. We suggest using this derived low dose of protamine (total heparin dose/1.6) through radial arterial route can be practical and efficient to reverse the effect of heparin after cardiac surgery without using central route (ascending aorta or central venous line).