title: Characteristics of uncontrolled hemorrhage in cardiac surgery.
abstract: Patients with uncontrolled hemorrhage require massive transfusion therapy and consume a large fraction of blood bank resources. Institutional guidelines have been established for treatment, but early identification and prevention in susceptible patients remains challenging. Uncontrolled hemorrhage was defined as meeting institutional guidelines for recombinant FVIIa administration. Patients who received rFVIIa were compared with patients who did not require the therapy but who were operated on during the same time period. After institutional review board approval, demographic, operative, and transfusion data were analyzed from a prospective database. Patients receiving rFVIIa were more likely to undergo multiple procedures (2.6 +/- 0.8 vs. 1.8 +/- 0.8; p < .001); aortic surgery (59% vs. 11%; p < .005); have a higher Cleveland Clinic Clinical Severity score (7.8 +/- 2.7 vs. 5.5 +/- 4.0; p < .005); require longer bypass (265 +/- 92 min vs. 159 +/- 63 min; p < .001), cross-clamp (182 +/- 68 min vs. 112 +/- 56 min; p < .001), and circulatory arrest (15 +/- 24 min vs. 2 +/- 7 min; p < .05) times; and require more autotransfusion (2580 +/- 1847 mL vs. 690 +/- 380 mL; p < .05). Uncontrolled hemorrhage is associated with more complex surgery requiring longer bypass times and more autotransfusion.
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania 17821, USA. cctrowbridge@geisinger.edu
authors.forename: Cody
authors.initials: C
authors.lastname: Trowbridge
authors.forename: Alfred
authors.initials: A
authors.lastname: Stammers
authors.forename: Myra
authors.initials: M
authors.lastname: Klayman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Brindisi
authors.forename: Edward
authors.initials: E
authors.lastname: Woods
mesh_terms: D000368:Aged; D016913:Blood Component Transfusion; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016022:Case-Control Studies; D015942:Factor VIIa / Q000627:therapeutic use; D006324:Heart Arrest, Induced; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa