Measurement of lactate in a prehospital setting is related to outcome

We evaluated the relationship of lactate measured in a preclinical setting with outcome. Simultaneously, we evaluated the feasibility of implementing blood lactate measurement in a prehospital setting as part of a quality improvement project.

Chart review of patients from whom serum lactate levels prospectively were obtained in a prehospital setting. Total population was divided into two groups, that is, a shock group and a non-shock group according to the predefined shock symptoms. The shock group was divided into two groups, that is, a lactate less than 4 mmol/l (subgroup I) and a lactate of at least 4 mmol/l (subgroup II).

In about 50% of possible cases, lactate was measured in the prehospital setting. Median lactate in subgroup I (n = 74) was 3.2 (1.5-3.9) mmol/l versus 5.0 (4.0-20.0) mmol/l in subgroup II (n = 61) (P<0.0001). Significant differences were found in length of stay in intensive care unit (P = 0.03) or hospital (P = 0.04) and mortality (subgroup I 12.2% vs. subgroup II 44.3%; P = 0.002). In normotensive shock patients showing a lactate of at least 4 mmol/l (n = 27), the mortality was higher compared with normotensive shock patients with a lactate less than 4 mmol/l (n = 31) (35 vs. 7%; P<0.001).

Implementation of lactate measurement in prehospital setting is feasible, and potentially clinical relevant. Lactate measured in a preclinical setting is related to outcome. Subsequent studies should evaluate whether treatment of shock patients based on prehospital lactate measurement will improve outcome.