Use of thromboelastograph and factor VII for the treatment of postoperative bleeding in a pediatric patient on ECMO after cardiac surgery

This report describes a case of possibly fatal bleeding treated successfully with an "overdose" of recombinant factor VII (rFVII; Novo7). A 3.5-year-old boy had surgery for aortic stenosis and aortic arch repair and was placed on extracorporeal membrane oxygenation (ECMO) after a prolonged cardiopulmonary bypass time (CPB); there was subsequent failure to wean from CPB because of right ventricular failure. Subsequently, a severe coagulopathy developed, and despite large volume transfusions with blood and blood products, this was unresolved. Thromboelastograph (TEG) measurements were obtained, and on the advice of the Hematology Department, Novo7 (recommended dose: 15-30 microg/kg) was administered at a dose of 200 microg/kg because of the severity of the bleeding. TEG was repeated, and a further dose of Novo7 was administered at 500 microg/kg; a further TEG after 15 minutes showed normalization, and the remaining bleeding was treated surgically. The patient was weaned from ECMO 48 hours later and was subsequently discharged home with no further problems. Novo7 in an "overdose" can apparently correct major coagulopathy even in patients on ECMO support with no dire effects on the ECMO circuit or the patient in a life-threatening scenario.