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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 marie.mullen@umassmemorial.org
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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 

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