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Recombinant factor VIIa for control of hemorrhage: early experience in critically ill trauma patients
Richard P Dutton1, John R Hess, Thomas M Scalea
1Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
Study Objective:
To examine our institutional experience with recombinant Factor VIIa (rFVIIa) as a treatment for exsanguinating hemorrhage in critically ill trauma patients.
Design:
Retrospective case review.
Setting:
A specialized trauma and critical care hospital, serving as the quaternary referral center for trauma and surgical shock in the state of Maryland.
Patients:
All patients with diffuse coagulopathy and impending exsanguination, given rFVIIa in an effort to control life-threatening hemorrhage. Patients were in the intensive care unit (ICU) or operating room (OR) and included both acute admissions and late-stage patients with multiple organ system failure.
Interventions:
Patients of interest were those that had received rFVIIa.
Measurements:
Examination of medical records, including pharmacy data, laboratory results, and the institutional trauma registry.
Main Results:
Administration of rFVIIa contributed to successful control of hemorrhage in three of five patients. Failure in two patients was mostly likely due to overwhelming shock and acidosis.
Conclusions:
Administration of rFVIIa shows promise in the treatment of exsanguinating hemorrhage. Prospective, controlled clinical trials of this therapy are strongly recommended.