Logan Reid
Prehospital lactate measurement is a valuable tool for emergency medical services in patients meeting sepsis criteria or suffering from circulatory, respiratory, or neurological disorders. It can help predict the need for immediate interventions for hemorrhage and guide resuscitative care. Point-of-care lactate measurement devices, such as handheld lactate meters, show promise for prehospital use, but further validation is needed to ensure accuracy in different settings. Prehospital lactate levels can be influenced by various factors, including injury type and treatments administered on the scene, and have been shown to predict the need for resuscitative in-hospital care and patient outcomes.
| Characteristics | Values |
|---|---|
| Use | Predicting the need for immediate interventions for hemorrhage after trauma |
| Guiding the management of patients with circulatory disturbance in trauma | |
| Guiding triage and advanced treatment decision-making | |
| Diagnosing sepsis | |
| Devices | Portable devices such as point-of-care (POC) devices |
| Handheld devices such as Accutrend and StatStrip Xpress Lactate Meter (SSX) | |
| Blood gas analyser, ABL90 FLEX (ABL90) | |
| Time Interval | The median time interval between prehospital lactate measurement and ED lactate value was 111 minutes |
| The median time interval between prehospital lactate measurement and ED specimen collection was 64 minutes | |
| Cost | $2.00 per measurement |
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What You'll Learn
- Portable devices for point-of-care lactate testing
- Prehospital lactate as a tool for urgent ambulance dispatch
- Prehospital lactate levels in trauma patients
- Prehospital lactate levels in patients with circulatory, respiratory, or neurological disorders
- Prehospital lactate levels as a predictive tool for resuscitative care
Portable devices for point-of-care lactate testing
One such device is the Lactate Pro 2 Blood Lactate Meter, a portable and simplified point-of-care device that provides precise measurements of blood lactate levels. It is a technically advanced version of the original Lactate Pro, offering faster, cheaper, and more accurate results. The Lactate Pro 2 requires only a small amount of blood (0.3μl) and provides measurement values within 15 seconds. Its compact and lightweight design makes it ideal for pre-hospital use.
Another portable lactate testing device is the Lactate Plus Meter, which is intended for sports training and conditioning. While it may not be specifically designed for medical use, it can still provide valuable lactate measurements for performance analysis.
The i-STAT point-of-care hand-held analyser is another noteworthy device. It offers superior accuracy and reliability, especially at higher lactate concentrations. However, its purchase cost, analysis time, and consumables costs are significantly higher than those of other analysers.
Additionally, the Edge and Xpress portable analysers have been found to have low total error for lactate concentrations below 15 mM, making them suitable for specific use cases.
These portable devices for point-of-care lactate testing offer rapid and convenient solutions for healthcare providers, enabling them to make timely decisions and provide appropriate care to patients, even in pre-hospital settings.
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Prehospital lactate as a tool for urgent ambulance dispatch
Prehospital lactate measurement is a valuable tool for urgent ambulance dispatch, particularly for patients with circulatory, respiratory, or neurological disorders. It can also be used as a predictive tool for resuscitative care and trauma activation level.
Lactate levels can be measured using portable, handheld devices, which are easy to operate with limited training. These devices are especially useful in prehospital settings, enabling point-of-care lactate testing. However, the accuracy of these devices in prehospital settings needs further validation. The cost per lactate measurement is relatively low at $2.00, making it highly translatable into clinical practice.
The blood lactate level is a useful biomarker that reflects poor tissue perfusion and is used to guide the management of patients with circulatory disturbances in trauma cases. It can help predict the need for immediate interventions for hemorrhage after trauma, improving patient outcomes.
Additionally, prehospital lactate measurements can be used in patients meeting sepsis criteria. While elevated prehospital lactate levels may indicate a higher likelihood of ICU admission and sepsis diagnosis, the differences were not statistically significant in one study. Further research is needed to strengthen the findings.
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Prehospital lactate levels in trauma patients
A study conducted by Air Ambulance Kent, Surrey & Sussex (AAKSS) between July 2017 and April 2018 measured pre-hospital lactate levels in 156 trauma patients. The median lactate level was 3.0 [2.0-4.1] mmol/l. Patients with elevated lactate levels more frequently exhibited deranged indices of end organ perfusion and oxygenation.
Another study, focusing on patients meeting sepsis criteria, found that subjects with prehospital lactate levels ≥ 4.0 mmol/L were more likely to be admitted to the ICU, receive a diagnosis of sepsis, and die during hospitalization. However, these differences were not statistically significant.
Prehospital lactate measurements have also been found to improve the prediction of the need for immediate interventions for hemorrhage after trauma. By adding blood lactate levels at the scene to physiological variables, the predictive value for immediate intervention significantly increased.
Overall, prehospital lactate levels can provide valuable information for triage and treatment decisions, particularly in trauma patients.
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Prehospital lactate levels in patients with circulatory, respiratory, or neurological disorders
Prehospital lactate levels are an important indicator of the need for immediate interventions for patients with circulatory, respiratory, or neurological disorders. The blood lactate level reflects poor tissue perfusion and is used to guide the management of patients with circulatory disturbances in trauma cases.
Point-of-care lactate testing can be performed in prehospital settings using portable devices, aiding in the prediction of the necessity for immediate interventions for hemorrhage after trauma. This is especially useful for patients requiring urgent ambulance dispatch. The cost per measurement is relatively low at $2.00, making it highly translatable into clinical practices.
In a study of 435 trauma patients, prehospital blood lactate levels were measured and assessed retrospectively. The addition of physiological variables and Lac scene significantly increased the predictive value for immediate intervention, such as surgical or radiological intervention and/or blood transfusion within 24 hours.
Furthermore, prehospital lactate measurements can be useful in predicting the need for resuscitative care and determining the trauma activation level. It can also be beneficial for initial in-hospital triage to identify patients requiring early trauma team activation and surgical intervention. However, it's important to note that prehospital lactate levels alone may not be sufficient for diagnostic accuracy, and other patient factors and treatment characteristics should be considered.
In conclusion, prehospital lactate levels serve as a valuable tool for guiding the management of patients with circulatory, respiratory, or neurological disorders. The ability to measure lactate levels in prehospital settings enhances the prediction of the need for immediate interventions, particularly in trauma cases. However, it should be used in conjunction with other clinical assessments for comprehensive patient evaluation and treatment decision-making.
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Prehospital lactate levels as a predictive tool for resuscitative care
Lactate, also known as lactic acid, is produced by cells as the body turns food into energy (cell metabolism). The highest level of production occurs in the muscles. Normally, the level of lactate in the blood and cerebrospinal fluid is low. However, when there is insufficient oxygen at the cellular level or when the primary way of producing energy in the body's cells is disrupted, lactate is produced in excess by muscle cells, red blood cells, the brain, and other tissues.
Excess lactate can lead to lactic acidosis, a condition where the blood becomes too acidic. Lactic acidosis can be caused by various conditions that fall into two main groups: conditions that reduce the amount of oxygen that reaches cells, and conditions that affect how much oxygen the body uses and how it produces or eliminates excess lactate.
Lactate levels can be measured in the blood or, less commonly, in the cerebrospinal fluid. Blood lactate levels can be measured from a vein or an artery, with arterial blood gas (ABG) tests considered more accurate. To collect blood from a vein, a small needle is inserted into the patient's arm to collect a small amount of blood. Arterial blood collection is usually performed on an artery inside the wrist.
Point-of-care (POC) serum lactate measurement is emerging as a valuable tool in prehospital clinical assessment. It has the potential to guide triage and advanced treatment decision-making, particularly in trauma patients. Prehospital lactate levels have been shown to predict the need for resuscitative in-hospital care and to predict the outcome of trauma patients.
Several studies have demonstrated the predictive value of prehospital lactate (PLac) measurements in hypotensive trauma patients. However, its value in a broader population of normotensive trauma patients transported by advanced life support (ALS) units has not been established. Prehospital lactate levels can inform the decision of whether to triage a patient to a trauma center, as traditional decision rules based on vital sign abnormalities are often insensitive in predicting severe injury.
In conclusion, prehospital lactate levels have the potential to be a valuable predictive tool for resuscitative care, especially in trauma patients. Further research and validation are needed to fully understand the role of PLac measurements in guiding prehospital care and improving patient outcomes.
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Frequently asked questions
Measuring lactate levels pre-hospital can be used as a tool for urgent ambulance dispatch for patients with circulatory, respiratory, or neurological disorders. It can also be used as a predictive tool for resuscitative care and the designation of trauma activation level.
Portable devices, such as handheld point-of-care (POC) lactate meters, can be used to measure lactate levels pre-hospital. These devices are easy to handle with limited training and are useful when rapid results are vital to the care of critically ill people.
The accuracy of handheld POC devices in measuring lactate levels pre-hospital is yet to be determined and validated. The results from lactate POC tests may not be comparable with those from tests performed in a laboratory due to differences in measurement methods.
