Subtherapeutic ACT Pre-CPB — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaSubtherapeutic ACT Pre-CPBFRCA Final

ACT 380 seconds after heparin 300 IU/kg before CPB. Target >480. Action?

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Correct answer: A — Additional heparin 100 IU/kg and recheck

ACT 380 is subtherapeutic. Give additional heparin ~100 IU/kg and recheck. If heparin resistance (repeated failures): antithrombin III deficiency → AT-III concentrate or FFP. Never initiate CPB with subtherapeutic ACT: catastrophic circuit thrombosis risk.

Reference: RCOA – 2023 – Anticoagulation during CPB