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

Cade M Nylund1, Matthew A Borgman, John B Holcomb

  • 1Department of Pediatrics, Willford Hall Medical Center, San Antonio, TX, USA. e.s.veldhoen@umcutrecht.nl

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|March 7, 2009
PubMed

Insights

Thromboelastography (TEG) guided resuscitation effectively managed coagulopathy in a pediatric trauma patient requiring massive transfusion, preventing intracranial hemorrhage and ensuring survival. This case highlights TEG

Area of Science:

  • Trauma resuscitation
  • Coagulation management
  • Pediatric critical care

Background:

  • Massive transfusion protocols are critical in managing life-threatening traumatic injuries.
  • Coagulopathy is a common and dangerous complication in severely injured patients.
  • Traditional coagulation tests may not fully capture the dynamic nature of hemostasis in trauma.

Observation:

  • A 5-year-old boy with a severe liver injury and arterial laceration presented with coagulopathy.
  • Thromboelastography (TEG) was utilized to guide hemostatic resuscitation efforts.
  • Recombinant activated factor VII was administered as part of the TEG-directed therapy.

Findings:

  • TEG-directed resuscitation successfully managed the patient's coagulopathy.
  • This approach was associated with the prevention of increased intracranial hemorrhage.
  • The patient survived the life-threatening traumatic injury.

Implications:

  • Thromboelastography (TEG) shows potential as a valuable tool for directing hemostatic resuscitation in pediatric trauma.
  • TEG offers a rapid and comprehensive assessment of the coagulation cascade, enabling targeted treatment.
  • This case supports the use of TEG for optimizing transfusion strategies in critically injured patients with coagulopathy.
Abstract

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