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Activated recombinant factor VII for refractory bleeding during extracorporeal membrane oxygenation

Robert A Niebler1, Rowena C Punzalan, Marisela Marchan

  • 1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. rniebler@mcw.edu

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 30, 2009
PubMed

Insights

Activated recombinant factor VII (rFVIIa) use during extracorporeal membrane oxygenation (ECMO) reduced bleeding severity without increasing thromboembolic events. This finding supports rFVIIa as a potential treatment for bleeding in critically ill patients on ECMO.

Area of Science:

  • Pediatric critical care medicine
  • Hematology
  • Cardiopulmonary support

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill patients with severe cardiopulmonary failure.
  • Bleeding complications are a significant concern in patients undergoing ECMO therapy.
  • Activated recombinant factor VII (rFVIIa) has been explored as a hemostatic agent in various bleeding scenarios.

Purpose of the Study:

  • To evaluate the safety and efficacy of activated recombinant factor VII (rFVIIa) in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support.
  • To determine the frequency of adverse events, specifically thromboembolic complications, associated with rFVIIa use during ECMO.
  • To quantify the impact of rFVIIa on bleeding parameters in ECMO patients.

Main Methods:

  • Retrospective case series conducted at a tertiary academic children's hospital.
  • Analysis included 17 pediatric patients who received rFVIIa during or shortly after ECMO initiation (February 2003 to August 2006).
  • Comparison was made with 23 historical control patients who received ECMO prior to rFVIIa availability (January 1999 to December 2002).

Main Results:

  • No significant differences were observed in thromboembolic complications, ECMO circuit failures, or mortality between the rFVIIa group and historical controls.
  • A significant reduction in chest tube output and blood product transfusion requirements was noted within 5 hours of rFVIIa administration.
  • No trend towards increased survival was identified, and circuit complications occurred in both groups.

Conclusions:

  • Activated recombinant factor VII administration during ECMO support is associated with decreased bleeding severity.
  • The use of rFVIIa in this context did not lead to an increased rate of thromboembolic complications.
  • rFVIIa may be a valuable adjunct for managing bleeding in pediatric patients on ECMO.
Abstract

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