title: Thromboelastography to direct the administration of recombinant activated factor VII in a child with traumatic injury requiring massive transfusion.
abstract: OBJECTIVE
  To describe the use of thromboelastography (TEG) to direct hemostatic resuscitation in a child with traumatic injury requiring massive transfusion.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Level 1 pediatric trauma center in an academic tertiary care facility.
  
  
  METHODS
  A 5-year-old boy with grade IV liver injury and right common hepatic artery laceration.
  
  
  METHODS
  TEG-directed resuscitation, including recombinant activated factor VII.
  
  
  RESULTS
  Measurements included vital signs, laboratory results to include TEG values, and blood product administration. TEG-directed resuscitation with recombinant activated factor VII was associated with the prevention of increased intracranial hemorrhage and survival in a coagulopathic patient with a life-threatening traumatic injury.
  
  
  CONCLUSIONS
  Our clinical and TEG laboratory results postresuscitation support the potential use of TEG as a tool to direct hemostatic resuscitation in patients with severe trauma requiring massive transfusion. TEG is a quick and focused method of qualitatively assessing the entire coagulation cascade, from clot formation to fibrinolysis that permits a targeted transfusion approach to the treatment of coagulopathy. TEG has the potential to rapidly and effectively direct hemostatic resuscitation in patients with the coagulopathy of trauma.
authors.affiliation: Department of Pediatrics, Willford Hall Medical Center, San Antonio, TX, USA. e.s.veldhoen@umcutrecht.nl
authors.forename: Cade M
authors.initials: CM
authors.lastname: Nylund
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Borgman
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Donald
authors.initials: D
authors.lastname: Jenkins
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
mesh_terms: D001803:Blood Transfusion; D002675:Child, Preschool; D015942:Factor VIIa / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage; D013916:Thrombelastography; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa