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

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.