title: [Use of rFVIIa in intractable hemorrhage in patients on central veno-arterial ECMO].
abstract: OBJECTIVE
  The purpose of our study is to describe the use of recombinant factor VIIa (rFVIIa) in patients on central veno-arterial ECMO with a particular attention on associated thrombotic complications.
  
  
  METHODS
  Monocentric retrospective study.
  
  
  METHODS
  We examined 91 files of patients on ECMO between 2005 and 2010. During this period, eight patients presented refractory bleeding and benefited from rFVIIa treatment.
  
  
  RESULTS
  In six of the eight patients, the bleeding stopped. A decrease of the bleeding was noticed after the treatment of rFVIIa (before rFVIIa: 40.1±33.1mL/kg per 3 hours after rFVIIa: 5.4±3.2mL/kg per 3 hours (P=0.01). The transfusional needs were decreased after administration of rFVIIa. No thrombotic event was detected. Fibrinogen, d-dimers, platelet count and lactate were not modified by the treatment. Two patients were weaned from ECMO. One patient died 17 days after the weaning. The other patient survived without neurological damages.
  
  
  CONCLUSIONS
  The rFVIIa is a treatment of exception for patients on central veno-arterial ECMO and could be a last-resort treatment in the presence of a not curable massive bleeding.
authors.affiliation: Département de chirurgie cardiovasculaire et transplantation, université de Lorraine, institut Louis-Mathieu du cœur et des vaisseaux, CHU de Nancy, 54511 Nancy, France. Electronic address: f.vanhuyse@chu-nancy.fr.
authors.forename: F
authors.initials: F
authors.lastname: Vanhuyse
authors.forename: B
authors.initials: B
authors.lastname: Frotscher
authors.forename: T
authors.initials: T
authors.lastname: Lecompte
authors.forename: P
authors.initials: P
authors.lastname: Maureira
authors.forename: J-P
authors.initials: JP
authors.lastname: Villemot
authors.forename: T
authors.initials: T
authors.lastname: Folliguet
authors.forename: M
authors.initials: M
authors.lastname: Toussaint-Hacquard
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004351:Drug Resistance; D015199:Extracorporeal Membrane Oxygenation; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000378:metabolism; D006470:Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000097:blood / Q000150:complications; D015300:Ventilator Weaning
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D011994:Recombinant Proteins; C036309:fibrin fragment D; D019344:Lactic Acid; D005340:Fibrinogen; C103587:recombinant FVIIa; D015942:Factor VIIa
keywords: ECLS; ECMO; Facteur VII activé recombinant; Hemorrhage; Hémorragie; Recombinant factor VIIa