Thromboelastography to direct the administration of recombinant activated factor VII in a child with traumatic injury requiring massive transfusion

Cade M. Nylund, Matthew A. Borgman, John B. Holcomb, Donald Jenkins, Philip C. Spinella

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)e22-e26
JournalPediatric Critical Care Medicine
Volume10
Issue number2
DOIs
StatePublished - Mar 1 2009
Externally publishedYes

Keywords

  • Children
  • Coagulopathy
  • Recombinant activated factor VII
  • Thromboelastography
  • Trauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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