Faculty Collaboration Database

Use of recombinant factor VIIa for refractory hemorrhage during extracorporeal membrane oxygenation. Pediatr Crit Care Med 2005 May;6(3):348-51

Date

04/29/2005

Pubmed ID

15857537

DOI

10.1097/01.PCC.0000161623.51275.0F

Scopus ID

2-s2.0-19444375493 (requires institutional sign-in at Scopus site)   48 Citations

Abstract

OBJECTIVE: To describe the outcome and treatment of two patients with recombinant factor VIIa (rFVIIa) for severe hemorrhage associated with extracorporeal membrane oxygenation (ECMO).

DESIGN: Case report.

SETTING: A 38-bed pediatric intensive care unit and 20-bed pediatric cardiac intensive care unit at a tertiary care children's hospital.

PATIENT: Two patients with life-threatening hemorrhagic complications associated with ECMO requiring massive transfusion of blood products.

INTERVENTIONS: Administration of repeated doses of rFVIIa at 90 microg/kg/dose.

MEASUREMENT AND MAIN RESULTS: PATIENT 1 was an 11-yr-old male with a dilated cardiomyopathy who had undergone an orthotopic heart transplant treated with venoarterial ECMO postoperatively for right ventricular dysfunction. PATIENT 2 was a 13-yr-old male treated with venoarterial ECMO for cardiopulmonary failure from necrotizing staphylococcal pneumonia. Both patients had severe hemorrhage from the cannulation sites and thoracostomy tubes requiring massive transfusion to maintain intravascular blood volume and replace clotting factors. Both patients were treated with rFVIIa every 2-4 hrs and attained hemostasis. PATIENT 1 was administered three doses and PATIENT 2 was administered ten doses. No evidence of abnormal thrombus formation was noted in their respective ECMO circuits.

CONCLUSIONS: The efficacy of rFVIIa in reducing intractable bleeding postcardiac surgery and in other coagulopathic states is being investigated. Despite theoretical concerns of thrombosis, these cases illustrate that there may be a role for the cautious use of rFVIIa in treating severe and intractable hemorrhage associated with ECMO.

Author List

Dominguez TE, Mitchell M, Friess SH, Huh JW, Manno CS, Ravishankar C, Gaynor JW, Tabbutt S

Author

Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Extracorporeal Membrane Oxygenation
Factor VII
Factor VIIa
Hemorrhage
Hemostatics
Humans
Intensive Care Units, Pediatric
Male
Recombinant Proteins