Life threatening cardiopulmonary failure in an infant following protamine reversal of heparin after cardiopulmonary bypass

Life threatening cardiopulmonary failure following protamine reversal of he parin after cardiopulmonary bypass (CPB) was reported to occur in adults bu t rarely in children. Atrial septal defect closure was performed in a 6-wee k-old infant erroneously suspected to suffer from right atrial thrombosis i n addition. Protamine administration after CPB led to critical pulmonary hy pertension and severe haemorrhagic pulmonary oedema resulting in severe hyp oxia. Inhaled nitric oxide, together with high frequency oscillation ventil ation supplemented by intravenous prostacycline, enabled complete recovery of cardiopulmonary and neurological function. Life threatening cardiovascul ar compromise after intravenous protamine can occur even in young infants w hich then require challenging paediatric critical care.