Recombinant factor VII for severe bleeding during extracorporeal membrane oxygenation following open heart surgery

Severe bleeding is a recognized complication during mechanical cardiopulmonary support with extracorporeal membrane oxygenation. We present the use of recombinant activated factor VII (rFVIIa) for severe, refractory bleeding during extracorporeal membrane oxygenation support after open-heart surgery for congenital heart disease.

Retrospective review of all patients receiving rFVIIa on extracorporeal membrane oxygenation.

A pediatric extracorporeal membrane oxygenation center located within the cardiac intensive care unit of a tertiary care children's hospital.

Four patients treated with rFVIIa for refractory bleeding on extracorporeal membrane oxygenation.

The patients received rFVIIa for severe, refractory blood loss despite applying clotting products and aprotinin infusion and excluding surgical reasons.

rFVIIa was given 4-7 hrs after commencing extracorporeal membrane oxygenation; a second identical dose was administered 4 hrs later. Bleeding decreased significantly in all patients within 30 mins after the first dose of rFVIIa; no side effects were observed.

rFVIIa is effective to achieve control of refractory hemorrhage in patients on extracorporeal membrane oxygenation. Now a randomized controlled trial to evaluate risks and benefits of rFVIIa on patients undergoing extracorporeal membrane oxygenation is required.