Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-25T05:41:10.883Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of Point-of-Care Lactate in the Prehospital Aeromedical Environment

Published online by Cambridge University Press:  19 March 2014

Marie Mullen ,
Gianluca Cerri ,
Ryan Murray ,
Angela Talbot ,
Alexandra Sanseverino ,
Peter McCahill ,
Virginia Mangolds ,
Jesse Volturo ,
Chad Darling  and
Marc Restuccia
Marie Mullen*
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
Gianluca Cerri
Affiliation:
Department of Emergency Medicine, Louisiana State University, Baton Rouge, Louisiana USA
Ryan Murray
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
Angela Talbot
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
Alexandra Sanseverino
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
Peter McCahill
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
Virginia Mangolds
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
Jesse Volturo
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
Chad Darling
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
Marc Restuccia
Affiliation:
Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA
*
Correspondence: Marie Mullen, MD Department of Emergency Medicine University of Massachusetts 55 Lake Avenue North Worcester, Massachusetts 01655 USA E-mail [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Lactate measurement has been used to identify critical medical illness and initiate early treatment strategies. The prehospital environment offers an opportunity for very early identification of critical illness and commencement of care.

Hypothesis

The investigators hypothesized that point-of-care lactate measurement in the prehospital aeromedical environment would: (1) identify medical patients with high mortality; (2) influence fluid, transfusion, and intubation; and (3) increase early central venous catheter (CVC) placement.

Methods

Critically ill, medical, nontrauma patients who were transported from September 2007 through February 2009 by University of Massachusetts (UMass) Memorial LifeFlight, a university-based emergency medical helicopter service, were eligible for enrollment. Patients were prospectively randomized to receive a fingerstick whole-blood lactate measurement on an alternate-day schedule. Flight crews were not blinded to results. Flight crews were asked to inform the receiving attending physician of the results. The primary endpoint was the ability of a high, prehospital lactate value [> 4 millimoles per liter (mmol/L)] to identify mortality. Secondary endpoints included differences in post-transport fluid, transfusion, and intubation, and decrease in time to central venous catheter (CVC) placement. Categorical variables were compared between groups by Fisher's Exact Test, and continuous variables were compared by t-test.

Results

Patients (N = 59) were well matched for age, gender, and acuity. In the lactate cohort (n = 20), mean lactate was 7 mmol/L [Standard error of the mean, SEM = 1]. Initial analysis revealed that prehospital lactate levels of ≥4 mmol/L did show a trend toward higher mortality with an odds ratio of 2.1 (95% CI, 0.3-13.8). Secondary endpoints did not show a statistically significant change in management between the lactate and non lactate groups. There was a trend toward decreased time to post-transport CVC in the non lactate faction.

Conclusion

Prehospital aeromedical point-of-care lactate measurement levels ≥4 mmol/L may help stratify mortality. Further investigation is needed, as this is a small, limited study. The initial analysis did not find a significant change in post-transport management.

MullenM , CerriG , MurrayR , TalbotA , SanseverinoA , McCahillP , MangoldsV , VolturoJ , DarlingC , RestucciaM . Use of Point-of-Care Lactate in the Prehospital Aeromedical Environment. Prehosp Disaster Med. 2014;29(1):1-4.

Keywords

lactatepoint-of-careprehospital
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 2 , April 2014 , pp. 200 - 203
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Broder, G, Weil, MH. Excess lactate: an index of reversibility of shock in human patients. Science. 1964;143(3613):1457-1459.CrossRefGoogle ScholarPubMed
2. Nguyen, H, Rivers, E, Knoblich, B, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32(8):1637-1642.Google Scholar
3. Rivers, E, Nguyen, B, Havstad, S, et al. Early goal directed therapy collaborative group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377.Google Scholar
4. Rady, M, Rivers, E, Nowak, R. Resuscitation of the critically ill in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med. 1996;14(2):218-225.Google Scholar
5. Vandromme, M, Griffen, R, Weinberg, J, Rue, L, Kerby, J. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: could prehospital measures improve trauma triage? J Amer Coll Surg. 2010;210(5):861-867.Google Scholar
6. Callaway, D, Shapiro, N, Donnino, M, Baker, C, Rosen, C. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009;66(4):1040-1044.Google ScholarPubMed
7. Blow, O, Magliore, L, Claridge, J, Butler, K, Young, J. The golden hour and the silver day: detection and correction of hypoperfusion within 24 hours improves outcome from major trauma. J Trauma. 1999;47(5):964-969.Google Scholar
8. Lavery, R, Livingston, D, Tortella, B, Sambol, J, Slomovitz, B, Siegel, J. The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg. 2000;190(6):656-664.Google Scholar
9. Shapiro, N, Fisher, C, Donnino, M, et al. The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection. J Emerg Med. 2010;39(1):89-94.Google Scholar
10. Boldt, J, Kumle, B, Suttner, S, Haisch, G. Point-of-care (POC) testing of lactate in the intensive care patient. Accuracy, reliability, and costs of different measurement systems. Acta Anaesthesiol Scand. 2001;45(2):194-199.Google Scholar
11. Gaieski, D, Drumheller, B, Goyal, M, Fuchs, B, Shofer, F, Zogby, K. Accuracy of handheld point-of-care fingertip lactate measurement in the emergency department. West J Emerg Med. 2013;14(1):58-62.Google Scholar
12. Jansen, T, van Bommel, J, Mulder, P, Rommes, J, Schieveld, S, Bakker, J. The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study. Crit Care. 2008;12(6):R160.Google Scholar
13. Guyette, F, Suffoletto, B, Castillo, J, Quintero, J, Callaway, C, Puyana, J. Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study. J Trauma. 2011;70(4):782-786.Google Scholar
14. Van Beest, P, Mulder, P, Oetomo, S, van den Broek, B, Kuiper, M, Spronk, P. Measurement of lactate in a prehospital setting is related to outcome. Eur J Emerg Med. 2009;16(6):318-322.Google Scholar