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UTILITY OF PRE-HOSPITAL LACTATE MEASUREMENT FOR TRAUMA PATIENTS: A SYSTEMATIC REVIEW
  1. Christopher TM Lewis,
  2. David N Naumann,
  3. Mark J Midwinter,
  4. Nicholas Crombie
  1. University of Birmingham

Abstract

Background Serum lactate serves as a surrogate marker for tissue hypoxia following traumatic injury, and may be used to guide resuscitation. The portable, lightweight nature of handheld point-of-care monitoring devices enables lactate values to be readily available in the pre-hospital environment, whether in land or air based evacuation modalities. The current review evaluates the utility of pre-hospital lactate measurement in the management of trauma patients.

Methods The published literature up to 06 August 2015 was searched using Medline and EMBASE using pre-defined criteria (English language, pre-hospital lactate measurement, trauma patients; excluding non-trauma/mixed patient groups). The Newcastle-Ottawa Scale was used to assess risk of bias of individual studies.

Results Of 857 non-duplicate articles of interest, 5 articles met the inclusion criteria, and included four cohort studies and one cross-sectional study. There were 2049 patients included in all studies.

Key findings ▸ Pre-hospital lactate may be an independent prognostic marker of in-hospital mortality, multiple organ dysfunction, and requirement for transfusion or surgical intervention in trauma patients, particularly in blunt trauma.

▸ Pre-hospital lactate measurement may be more sensitive than systolic blood pressure in determining need for resuscitative care.

▸ Early lactate measurement may be particularly useful in the detection of occult hypotension, with elevated levels detectable within 30 minutes of injury.

▸ All current studies that investigate pre-hospital lactate were assessed as being at risk of bias.

Conclusions There is a paucity of evidence relating to pre-hospital lactate-guided management in trauma. From the limited literature, it seems that pre-hospital lactate may be a useful early tool in guiding the management of trauma patient resuscitation. Further prospective studies are required to elucidate the sensitivity and specificity of abnormal pre-hospital lactate values.

  • prehospital care

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