Document Detail


Novoseven use in a non-cardiac pediatric ECMO patient with uncontrolled bleeding.
MedLine Citation:
PMID:  18705548     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Despite the presence of normal coagulation values, refractory bleeding during extracorporeal membrane oxygenation (ECMO) is encountered. Occasionally, hemostasis is not achieved through traditional techniques including surgical exploration, anti-fibrinolytics, increasing fibrinogen level, increasing platelet counts, and decreasing activated clotting time (ACT). We report the case of an infant on veno-arterial ECMO for respiratory syncytial virus with severe bleeding and the use of recombinant activated factor VII (rFVIIa; NovoSeven; Novo Nordisk, Copenhagen, Denmark). This was a retrospective review of the patient's medical records, laboratory values, and chest radiographs. rFVIIa was given to this patient on two separate occasions for bleeding unresponsive to traditional bleeding management. On both occasions, the patient's blood loss returned to zero within 20 minutes of administration and remained there for a minimum of 4 days. Continued bleeding on ECMO unresponsive to current medical management may be an indication for rFVIIa. However, rFVIIa should not be administered without first considering the ECMO circuits conditions to include presence of clot, and documentation of circuit pressures, which, after rFVIIa, may be the first indication of intraoxygenator clot formation. Additionally, rFVIIa should not be a first-line treatment until continued studies allow for approved use in this patient population.
Authors:
Thomas J Preston; Vincent F Olshove; Onsy Ayad; Kathleen K Nicol; Jeffrey B Riley
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of extra-corporeal technology     Volume:  40     ISSN:  0022-1058     ISO Abbreviation:  J Extra Corpor Technol     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-08-18     Completed Date:  2008-10-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267637     Medline TA:  J Extra Corpor Technol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  123-6     Citation Subset:  T    
Affiliation:
Nationwide Children's Hospital, Columbus Ohio Circulation Technology Division, The Ohio State University, Columbus, Ohio, USA. Thomas.Preston@nationwidechildrens.org
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MeSH Terms
Descriptor/Qualifier:
Coagulants / therapeutic use*
Extracorporeal Membrane Oxygenation / adverse effects
Factor VIIa / therapeutic use*
Hemorrhage / drug therapy*,  etiology
Humans
Infant
Male
Recombinant Proteins / therapeutic use
Respiratory Insufficiency / etiology,  therapy
Respiratory Syncytial Virus Infections / complications
Chemical
Reg. No./Substance:
0/Coagulants; 0/Recombinant Proteins; 0/recombinant FVIIa; EC 3.4.21.21/Factor VIIa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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