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 journalArticle

24 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
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

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