I read with great interest the paper by Muzzi et al. [1] concerning the salvage use of Celox gauze (MedTrade Products Ltd, Cheshire, UK) in two patients and the postoperative course was uneventful. Celox gauze is a very effective haemostatic agent and it is capable of clotting heparinised blood [2]. However, its use is limited in controlling haemorrhage in a military trauma setting on the battlefield. The authors stated that despite the use of fresh frozen plasma, platelets, desmopressin and epsilon-aminocaproic acid, control of the bleeding was not achieved. I would like to ask the authors why they did not make use of activated recombinant factor VII or rFVIIa (NovoSeven®, Novo Nordisk, Denmark). Bleeding is a troublesome situation and carries a dismal prognosis in postoperative extracorporeal membrane oxygenation (ECMO) implantation for post-cardiotomy cardiogenic shock. Since 1999, rFVIIa has been used after cardiac surgery as a compassionate therapy for life- threatening haemorrhage [3]. Dramatic bleeding secondary to consumptive coagulopathy post-cardiopulmonary bypass has been shown to be successfully managed by the infusion of a single dose of 60-90 µg/kg of rFVIIa. However, previous compensation with fibrinogen (>1 g/l) and platelets (>50 g/l) is mandatory to ensure an effective clotting cascade. In a recent multicentre observational study [3] assessing the efficacy of rFVIIa in cardiac surgery, the authors concluded that a single dose of rFVIIa was sufficient to stop or decrease bleeding in 80% of their patients, of whom 34% (n = 37) were assisted by mechanical devices. Thrombotic events were the major drawback especially in patient with assist devices and occurred in 27% of them. A review of the literature published in 2006 [4] showed that rFVIIa was an effective homeostatic agent for intractable bleeding after cardiac surgery and the risk of serious, adverse thrombotic events was estimated to be under 1%. The usage of Celox in combination with a vacuum assisted closure device seems to be lifesaving and represents an effective and safe (thrombotic event-free) tool. It should be considered in the armamentarium of every cardiac surgeon.