Protamine Reaction Type III — FRCA Final MCQ

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HardCardiothoracic AnaesthesiaProtamine Reaction Type IIIFRCA Final

Protamine reaction: severe hypotension, bronchospasm, raised PA pressures 2 min after protamine. Classification?

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Correct answer: E — Type III — catastrophic pulmonary vasoconstriction

Protamine Type III: catastrophic pulmonary vasoconstriction with acute RV failure (thromboxane-mediated, non-immune). Hypotension + bronchospasm + raised PAP. Management: stop protamine, inhaled NO, RV inotropes, consider re-heparinise and return to CPB.

Reference: RCOA – 2023 – Protamine reactions