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Br J Anaesth. 2016 Oct;117(4):470-476. doi: 10.1093/bja/aew276.

Reduced mortality by meeting guideline criteria before using recombinant activated factor VII in severe trauma patients with massive bleeding.

Author information

1
Pôle Anesthésie Réanimation, CHU Grenoble Alpes, F-38000, Grenoble, France JFPayen@chu-grenoble.fr.
2
INSERM, U1216, F-38000 Grenoble, France.
3
Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France.
4
Pôle Anesthésie Réanimation, CHU Grenoble Alpes, F-38000, Grenoble, France.
5
Clinical Research Centre, INSERM 003, CHU Grenoble Alpes, F-38000, Grenoble, France.
6
Univ. Grenoble Alpes, CNRS-TIMC-IMAG UMR, 5525-ThEMAS, F-38000 Grenoble, France.
7
Pôle Anesthésie Réanimation, CHU de Lille, F-59037, Lille, France.
8
Pôle Urgences SAMU SMUR, Groupe Hospitalier Pellegrin, CHU de Bordeaux, F-33076, Bordeaux, France.
9
Service d'accueil des Urgences, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, F-75651, Paris, France.
10
Sorbonne Universités, UPMC Univ. Paris 6, UMRS INSERM 1166, IHU ICAN, Paris, France.

Abstract

BACKGROUND:

Management of trauma patients with severe bleeding has led to criteria before considering use of recombinant activated factor VII (rFVIIa), including haemoglobin >8 g dl-1, serum fibrinogen ≥1.0 g l-1, platelets >50,000 x 109 l-1, arterial pH ≥ 7.20, and body temperature ≥34 °C. We hypothesized that meeting these criteria is associated with improved outcomes.

METHODS:

In this prospective cohort study of 26 French trauma centres, subjects were included if they received rFVIIa for persistent massive bleeding despite appropriate care after severe blunt and/or penetrating trauma.

RESULTS:

After surgery and/or embolization as haemostatic interventions, 112 subjects received a first dose of 103 μg kg-1 rFVIIa (82-200) (median, 25th-75th percentile) at 420 min (285-647) post-trauma. Of these, 71 (63%) "responders" were still alive at 24h post-trauma and had their transfusion requirements reduced by > 2 packed red blood cell units after rFVIIa treatment. Mortality was 54% on day 30 post-trauma. There were 21%, 44% and 35% subjects who fulfilled 0-1, 2-3 or 4-5, respectively, of the guidelines before receiving rFVIIa. Survival at day 30 was 13%, 49% and 64% and the proportion of responders was 39%, 64% and 82%, when subjects fulfilled 0-1, 2-3 or 4-5 conditions, respectively (both P <0.01).

CONCLUSIONS:

In actively bleeding trauma patients, meeting guideline criteria before considering rFVIIa was associated with lower mortality and a higher proportion of responders to the rFVIIa.

KEYWORDS:

factor VIIa; haemorrhage; shock, traumatic

PMID:
28077534
DOI:
10.1093/bja/aew276
[Indexed for MEDLINE]
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