Recombinant activated factor VII for life-threatening pulmonary hemorrhage after pediatric cardiac surgery

Objective: To report intractable life-threatening pulmonary hemorrhage after cardiac surgery in an infant who was treated successfully with recombinant activated factor VII (rFVIIa). Design: Descriptive case report. Setting: An 18-bed pediatric intensive care unit at a tertiarycare children's hospital. Patient: A 10-wk-old child with acute life-threatening pulmonary hemorrhage after cardiac surgery. Interventions: General supportive intensive care. Measurements and Main Results: Care included mechanical ventilatory support, inotropic support, and concurrent treatment with blood products (packed cells, platelet concentrates, and plasma-derived products), as well as aprotinin and desmopressin to improve hemostasis. The addition of rFVIIa resulted in complete resolution of the hemorrhage. Conclusions: rFVIIa should be considered as a possible novel therapeutic approach to be used as rescue therapy for patients presenting with massive life-threatening hemorrhage progressing into hemorrhagic shock. Further controlled trials to elucidate the safety of this treatment are warranted. (Pediatr Crit Care Med 2003; 4:444 -446).