Recombinant factor VIIa for control of hemorrhage: early experience in critically ill trauma patients

Abstract

Study objective: To examine our institutional experience with recombinant Factor VIIa (rFVIIa) as a treatment for exsanguinating hemorrhage in critically ill trauma patients.

Design: Retrospective case review.

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

Patients: 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.

Interventions: Patients of interest were those that had received rFVIIa.

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

Main 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.