Successful ROTEM-guided transfusion therapy in a case of rural paediatric trauma

Area of Science:

• Trauma surgery
• Paediatric critical care
• Coagulation medicine

Background:

• Massive transfusion therapy is complex in severe pediatric trauma.
• Rural settings present challenges with delayed medical access, worsening coagulopathy.
• Timely intervention is crucial for managing trauma-induced coagulopathy.

Observation:

• A pediatric patient sustained severe lower limb amputation with delayed treatment initiation (3 hours post-injury) due to rural access difficulties.
• The patient presented with significant coagulopathy.
• Rotational thromboelastometry (ROTEM) was utilized for monitoring and guiding treatment.

Findings:

• ROTEM-guided, goal-directed hemostatic therapy was administered perioperatively.
• A specific blood product ratio (2:2:1 RBC:FFP:Platelets) was employed.
• This targeted therapy successfully reverted the patient's coagulopathy.

Implications:

• This case demonstrates the successful application of ROTEM in managing pediatric trauma-induced coagulopathy in a resource-limited setting.
• It underscores the potential of ROTEM to guide effective hemostatic resuscitation in complex pediatric trauma cases.
• Raising awareness of ROTEM's utility can improve outcomes for critically injured children in remote locations.