Successful Use of Factor VIIa to Control Life-threatening Post-operative Haemorrhage in a Patient on Extra-Corporeal Membrane Oxygenation

Safety and efficacy of recombinant activated factor VII for refractory hemorrhage in pediatric patients on extracorporeal membrane oxygenation: a single center review

“…12,13 In the pediatric patient on ECMO with severe hemorrhage, some case reports and retrospective reviews have shown improved hemostasis after its use, without severe thrombotic complications. 16 , 18–28…”

“…Other literature, using rFVIIa for hemorrhage while on ECMO, utilizes doses from 24 – 174 μg/kg (most commonly 90 μg/kg), with the total number of doses given per treatment episode from 1-4 and typical dosing intervals of every 1-4 hours. 16,19–28,36,38–43 A Cochrane Review in 2007 showed large variability in dosing and schedules, with an equally diverse group of patients, indications and co-interventions. 17 It is unclear whether there is a dose-effect relationship when utilizing rFVIIa.…”

Venoarterial Extracorporeal Membrane Oxygenation in Adults With Cardiac Arrest

“…69 Utilization of factor VII for patients with refractory bleeding on ECMO has demonstrated conflicting results, with some studies reporting the occurrence of fatal thromboses following its administration in ECMO patients. [74][75][76] Maintenance of positive pressure ventilation during ECMO therapy is important so as to avoid atelectasis and prevent pulmonary congestion-both of which can delay weaning from ECMO. Serum creatinine and urine output should be monitored to assess renal function as renal blood flow is decreased in patients receiving ECMO.…”

Succesful use of recombinant activated coagulation factor VII in a patient with veno-venous ECMO after lung transplantation

“…In spite of fact that normal values of fibrinogen, PLT and INR were achieved, coagulopathy was persistent. Off-label use of rFVIIa has been described as a rescue therapy to stop bleeding in patients on VA-EC-MO and in a few cases of paediatric VV-ECMO [11,12]. This patient presented with a life threatening coagulopathy and as a final strategy we chose rFVIIa instead of using multiple blood products, which were ineffective.…”