Use of Recombinant Factor VIIa for Control of Combat-Related Hemorrhage: Findings From the U.S. Navy-Marine Corps Combat Trauma Registry

摘要

New methods of hemorrhage control are needed for use in remote surgical locations, such as the battlefield. Data from the Navy-Marine Corps Combat Trauma Registry (CTR) describe recombinant activated human coagulation factor VII (FVIIa), a site-specific, intravascular approach to promote clotting, which is being used as an adjunct to surgical control of bleeding in trauma patients in the battlefield environment. The present 20-month retrospective study identified 22 casualties from the CTR who were wounded in Iraq and received FVIIa. Primarily young Marines, these patients typically had penetrating injuries from improvised explosive devices and gunshot wounds. Injuries were often abdominal, supporting the utility of FVIIa for noncompressible injuries. The average dose used was similar to that reported elsewhere, although dosing varies widely in the existing experimental and anecdotal literature. Over two thirds (68%) of the FVIIa patients survived. Survival outcomes did not differ significantly between the FVIIa group and a matched control group. Results are discussed in terms of battlefield applications for FVIIa and methodological limitations of the study.