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Post Cardiac Surgery, ACT not correctable with Protamine

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dawood99884
dawood99884

I am a paediatric cardiac surgeon and I have experienced a very odd coagulopathic phenomenon in 02 of my patients. Both patients were cynotic Single ventricle and had surgery on cardio-pulmonary bypass machine. 1st had a Cavo-pulmonary shunt (Glenn procedure) and 2nd had Fontan procedure. In both patients after bypass we had to give protamine 3 times to reverse the heparin effects. However the ACT remained above 200 in both cases, and patient were bleeding. We had to give Fresh Frozen Plasmas, Platelets and Cryo. We also have Factor VII, but all these efforts didn’t help and patients remained coagulopathic. Both patients went into DIC. The cardiopulmonary bypass time was 120 and 80 respectively in both patients. 

Can anyone please enlighten what might have gone wrong with these patients ???

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