Recombinant factor VIIa for control of hemorrhage: early experience in critically ill trauma patients.
OBJECTIVE
To examine our institutional experience with recombinant Factor VIIa (rFVIIa) as a treatment for exsanguinating hemorrhage in critically ill trauma patients.


METHODS
Retrospective case review.


METHODS
A specialized trauma and critical care hospital, serving as the quaternary referral center for trauma and surgical shock in the state of Maryland.


METHODS
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.


METHODS
Patients of interest were those that had received rFVIIa.


METHODS
Examination of medical records, including pharmacy data, laboratory results, and the institutional trauma registry.


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.
Dutton
Richard P
RP
Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
Hess
John R
JR
Scalea
Thomas M
TM
D000007:Abdominal Injuries / Q000628:therapy; D000058:Accidental Falls; D000138:Acidosis / Q000503:physiopathology; D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology; D003422:Critical Care; D015942:Factor VIIa / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006470:Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009102:Multiple Organ Failure / Q000628:therapy; D009873:Operating Rooms; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D012769:Shock / Q000503:physiopathology / Q000628:therapy; D014947:Wounds and Injuries / Q000503:physiopathology / Q000628:therapy*; D014948:Wounds, Gunshot / Q000628:therapy
D011994:Recombinant Proteins; D015942:Factor VIIa