Thromboelastography to direct the administration of recombinant activated factor VII in a child with traumatic injury requiring massive transfusion.
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.
Nylund
Cade M
CM
Department of Pediatrics, Willford Hall Medical Center, San Antonio, TX, USA. e.s.veldhoen@umcutrecht.nl
Borgman
Matthew A
MA
Holcomb
John B
JB
Jenkins
Donald
D
Spinella
Philip C
PC
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*
D011994:Recombinant Proteins; D015942:Factor VIIa