Tissue hypoxia following traumatic injury : Pre-hospital lactate-guided management in trauma

UTILITY OF PRE-HOSPITAL LACTATE MEASUREMENT FOR TRAUMA PATIENTS: A SYSTEMATIC REVIEW: 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.



http://ift.tt/2cgLdxk