title: Recombinant factor VIIa for uncontrollable bleeding in patients with extracorporeal membrane oxygenation: report on 15 cases and literature review.
abstract: BACKGROUND
  Bleeding is the most frequent complication in patients receiving venoarterial or venovenous extracorporeal membrane oxygenation (ECMO). Recombinant activated factor VII (rFVIIa) has been used in these patients with conflicting results. We describe our experience with rFVIIa for refractory bleeding in this setting and review the cases reported in the literature.
  
  
  METHODS
  Clinical characteristics, demographics, bleeding, thrombotic complications, mortality, and rFVIIa administration were retrospectively collected for analysis from the electronic charts of the 15 patients in our intensive care unit who received rFVIIa while being given ECMO from January 2006 to March 2011.
  
  
  RESULTS
  Fifteen patients received rFVIIa for persistent bleeding under venoarterial (n=11) or venovenous (n=4) ECMO. Bleeding dramatically decreased in 14 patients, without a major thrombotic event, except in one patient in whom a major stroke could not be ruled out. Two circuits were changed within the 48 hours after rFVIIa administration for clots in the membrane and decreased oxygenation but without massive clotting. The mortality rate was 60%.
  
  
  CONCLUSIONS
  rFVIIa use for intractable hemorrhaging in patients receiving ECMO controlled bleeding, without major thrombotic events, and with 60% dying. Hence, its use warrants discussion, and clinicians should be aware of the possibility of potentially life-threatening systemic thrombosis, emboli, or circuit clotting. Whether rFVIIa can save the lives of such patients remains to be determined.
authors.forename: Xavier
authors.initials: X
authors.lastname: Repessé
authors.forename: Siu Ming
authors.initials: SM
authors.lastname: Au
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bréchot
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa