Combined Use of Recombinant Activated Factor VII and ECMO in Severe Postoperative Bleeding after Cardiac Surgery in a Newborn: Death due to Ventricular Dysfunction

Background

Postoperative bleeding is the most important complication after surgical correction of heart defects. Currently no uniform therapeutic guidelines exist when surgical causes of bleeding are excluded and blood product transfusions have failed.

The use of recombinant activated factor VII (rFVIIa) as an “off label drug” for the treatment of severe postoperative bleeding, refractory to the transfusion protocol in pediatric patients without hemophilia has been described previously (Wittenstein et al. PediatrCritCareMed 2005; 6: 473–476).

Extracorporeal membrane oxygenation (ECMO) is indicated postoperative cardiac surgery when weaning from cardiopulmonary bypass (CPB) is not possible, whilst recuperation of ventricle function is expected. Other indications for cardiologic ECMO include therapy refractory hypotension, oliguria/anuria, metabolic acidosis.

Whereas the use of ECMO support as well as the administration of rFVIIa in severe postoperative bleeding are accepted individual treatment options, combined use of these 2 therapies is controversial due to the risk of thrombotic complications (O’Connell et al. JAMA 2006; 295: 293–298) and little experience exist in newborns.

We report the combined use of rFVIIa and ECMO in a newborn suffering from massive postoperative bleeding after cardiac surgery.