• Cade M Nylund, Matthew A Borgman, John B Holcomb, Donald Jenkins, and Philip C Spinella.
• Department of Pediatrics, Willford Hall Medical Center, San Antonio, TX, USA. e.s.veldhoen@umcutrecht.nl
• Pediatr Crit Care Me. 2009 Mar 1;10(2):e22-6.

ObjectiveTo describe the use of thromboelastography (TEG) to direct hemostatic resuscitation in a child with traumatic injury requiring massive transfusion.DesignCase report.SettingLevel 1 pediatric trauma center in an academic tertiary care facility.PatientA 5-year-old boy with grade IV liver injury and right common hepatic artery laceration.InterventionTEG-directed resuscitation, including recombinant activated factor VII.Measurements And Main ResultsMeasurements 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.ConclusionOur 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.

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