Medical-surgical management of traumatic cardiac rupture: Relevance of recombinant activated factor VII

The mortality rate from cardiac rupture by blunt chest injury is high. In multiple trauma patient, haemorrhage is a major cause of death. Regardless of aetiology, the management of massive bleeding requires immediate surgery with simultaneous stabilization of haemostasis and maintenance of normovolaemia. A pharmacological approach to reduce blood transfusion consists on the use of recombinant activated factor VII (rFVIIa). We report our experience with rFVIIa to control the haemorrhage in a blunt heart trauma with coagulopathy. The surgical exploration found a right haemothorax related to a pericardium rupture with two open wounds of the heart. The atrial and ventricular ruptures were repaired without cardiopulmonary bypass. The use of two consecutive doses (100 microg/kg) of rFVIIa during, and after surgery, reduced the need of transfusion. After this episode, the patient developed a transient cardiac dysfunction, and then was discharged from hospital. The use of rFVIIa reduced probably the need of blood transfusion in this case of blunt heart trauma. This treatment should be envisaged in similar cases after the failure of standard therapy to control the bleeding.