Use of nitric oxide for treatment of pulmonary hypertensive crisis in a child after protamine administration.

Introduction: Protamine is widely used to reverse heparin. However, protamine administration may cause systemic hypotension, pulmonary hypertension, anaphylactic shock, and cardiovascular collapse. (1) In one recent pediatric study, the only reaction seen was systemic hypotension. This was associated with small heparin dose, large protamine dose, and female gender with an incidence of 1.76%-2.88%. (2) We report a case of a child who developed pulmonary hypertensive crisis after protamine administration who was successfully treated with nitric oxide (NO).