Does Initiation of Protamine Necessitate Discontinuing Pump Sucker?

Background: Protamine is essential in cardiac surgery to reverse heparin effect. Despite the benefit of returning the shed blood back to patient through arterial line by using suction during and after using protamine, this practice has been unpredictably associated with the observation of clot in the cardiopulmonary bypass (CPB) circuit.
Objectives: This study aimed to evaluate the effect of protamine test dose on the activated clotting time value, which influence the timing of discontinuation of pump sucker.
Patients and methods: A prospective study that was conduct on 86 cardiac surgery cases in Menoufia University Hospitals. Effect of protamine test dose (PTD) on activated clotting time (ACT) was assessed to determine the proper timing for cessation of pump sucker.
Results: There was male predominance (60.5%) in the study group with a mean age of 49.57 years. Coronary artery bypass grafting (CABG) was the most frequent procedure in 38 cases (44.2%) followed by mitral valve replacement (MVR) in 16 cases (18.6%). There was a significant drop in the ACT after PTD, which was confirmed by comparing last ACT during CPB to that after PTD, which showed statistically significant difference.
Conclusion: The proper timing for cessation of field sucker is before initiation of protamine transfusion, so adequate hemostasis of surgical field should be obtained before ordering protamine transfusion.