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2013 ; 17
(2
): R55
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Recombinant factor VIIa for uncontrollable bleeding in patients with
extracorporeal membrane oxygenation: report on 15 cases and literature review
#MMPMID23531278
Repessé X
; Au SM
; Bréchot N
; Trouillet JL
; Leprince P
; Chastre J
; Combes A
; Luyt CE
Crit Care
2013[Mar]; 17
(2
): R55
PMID23531278
show ga
INTRODUCTION: Bleeding is the most frequent complication in patients receiving
venoarterial or venovenous extracorporeal membrane oxygenation (ECMO).
Recombinant activated factor VII (rFVIIa) has been used in these patients with
conflicting results. We describe our experience with rFVIIa for refractory
bleeding in this setting and review the cases reported in the literature.
METHODS: Clinical characteristics, demographics, bleeding, thrombotic
complications, mortality, and rFVIIa administration were retrospectively
collected for analysis from the electronic charts of the 15 patients in our
intensive care unit who received rFVIIa while being given ECMO from January 2006
to March 2011. RESULTS: Fifteen patients received rFVIIa for persistent bleeding
under venoarterial (n=11) or venovenous (n=4) ECMO. Bleeding dramatically
decreased in 14 patients, without a major thrombotic event, except in one patient
in whom a major stroke could not be ruled out. Two circuits were changed within
the 48 hours after rFVIIa administration for clots in the membrane and decreased
oxygenation but without massive clotting. The mortality rate was 60%.
CONCLUSIONS: rFVIIa use for intractable hemorrhaging in patients receiving ECMO
controlled bleeding, without major thrombotic events, and with 60% dying. Hence,
its use warrants discussion, and clinicians should be aware of the possibility of
potentially life-threatening systemic thrombosis, emboli, or circuit clotting.
Whether rFVIIa can save the lives of such patients remains to be determined.