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Risk factors for clinically important adverse events after protamine administration following cardiopulmonary bypass

Stephen E. Kimmel, MD, MS, FACC^* , Mikkael A. Sekeres, MD, MS^* , Jesse A. Berlin, ScD^*, Norig Ellison, MD, Verdi J. DiSesa, MD^|| and Brian L. Strom, MD, MPH^*

^* Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
^|| Division of Cardiothoracic Surgery, Department of Surgery, Allegheny University–East Falls, Philadelphia, Pennsylvania, USA

View larger version (11K): [in a new window]   Figure 1 Association between risk factors and adverse events using progressively more specific case definitions. Multivariable odds ratios and 95% confidence intervals (bars) are plotted on a logarithmic scale for risk factors that showed significant associations with the outcome when using the primary definition of adverse events. All odds ratios are adjusted for variables stated in footnote to Table 2. NPH = neutral protamine Hagedorn. Circles = all events; diamonds = all events within 20 min; squares = events within 20 min without other causes; triangles = events within 10 min without other causes (primary definition).

View larger version (12K): [in a new window]   Figure 2 Association between risk factors and adverse events using progressively more specific case definitions. Multivariable odds ratios and 95% confidence intervals (bars) are plotted on a logarithmic scale for risk factors that did not show a significant association with the outcome when using the primary definition of adverse events. All odds ratios are adjusted for variables stated in footnote to Table 2, except for the odds ratios for protamine allergy, which are unadjusted. The odds ratios for protamine allergy for events defined as those occurring within 10 min of protamine in the absence of other causes of hemodynamic compromise are undefinable. The odds ratios for central venous pressure are for each 5-mm increase, and the odds ratios for ejection fraction are for each 10 percentage point increase. CVP = central venous pressure; EF = ejection fraction. Symbols as in Figure 1.