Journal of Emergencies, Trauma, and Shock
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ORIGINAL ARTICLE
Year : 2014  |  Volume : 7  |  Issue : 2  |  Page : 102-111

Use of recombinant factor VIIa (rFVIIa) as pre-hospital treatment in a swine model of fluid percussion traumatic brain injury


1 Department of Neuro Trauma, Naval Medical Research Center, Silver Spring, Maryland, USA
2 Department of Neuro Trauma, Naval Medical Research Center, Silver Spring; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
3 Department of Veterinary Pathology, Naval Medical Research Center, Silver Spring, Maryland, USA

Correspondence Address:
Ashraful Haque
Department of Neuro Trauma, Naval Medical Research Center, Silver Spring, Maryland
USA
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Source of Support: This work was supported by BUMED Core Capability Funding Work Unit Number 602236N.M04426. B26.A0241., Conflict of Interest: None


DOI: 10.4103/0974-2700.130880

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Context: Recombinant factor VIIa (rFVIIa) has been used as an adjunctive therapy for acute post-traumatic hemorrhage and reversal of iatrogenic coagulopathy in trauma patients in the hospital setting. However, investigations regarding its potential use in pre-hospital management of traumatic brain injury (TBI) have not been conducted extensively. Aims: In the present study, we investigated the physiology, hematology and histology effects of a single pre-hospital bolus injection of rFVIIa compared to current clinical practice of no pre-hospital intervention in a swine model of moderate fluid percussion TBI. Materials and Methods: Animals were randomized to receive either a bolus of rFVIIa (90 μg/kg) or nothing 15 minutes (T15) post-injury. Hospital arrival was simulated at T60, and animals were euthanized at experimental endpoint (T360). Results: Survival was 100% in both groups; baseline physiology parameters were similar, vital signs were comparable. Animals that received rFVIIa demonstrated less hemorrhage in subarachnoid space (P = 0.0037) and less neuronal degeneration in left hippocampus, pons, and cerebellum (P = 0.00009, P = 0.00008, and P = 0.251, respectively). Immunohistochemical staining of brain sections showed less overall loss of microtubule-associated protein 2 (MAP2) and less Flouro-Jade B positive cells in rFVIIa-treated animals. Conclusions: Early pre-hospital administration of rFVIIa in this swine TBI model reduced neuronal necrosis and intracranial hemorrhage (ICH). These results merit further investigation of this approach in pre-hospital trauma care.


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