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  • Title: Thromboelastography to direct the administration of recombinant activated factor VII in a child with traumatic injury requiring massive transfusion.
    Author: Nylund CM, Borgman MA, Holcomb JB, Jenkins D, Spinella PC.
    Journal: Pediatr Crit Care Med; 2009 Mar; 10(2):e22-6. PubMed ID: 19265363.
    Abstract:
    OBJECTIVE: To describe the use of thromboelastography (TEG) to direct hemostatic resuscitation in a child with traumatic injury requiring massive transfusion. DESIGN: Case report. SETTING: Level 1 pediatric trauma center in an academic tertiary care facility. PATIENT: A 5-year-old boy with grade IV liver injury and right common hepatic artery laceration. INTERVENTION: TEG-directed resuscitation, including recombinant activated factor VII. MEASUREMENTS AND MAIN 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. CONCLUSION: 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.
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