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Arriving by emergency medical services improves time to treatment endpoints for patients with severe sepsis or septic shock.. Acad Emerg Med. 2011; 18:(9)934-40

Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study.. The Lancet. 2002; 359:(9306)558-63

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Early increases in blood lactate following injury.. J R Army Med Corps. 2002; 148:(2)140-3

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Lactate measurement in pre-hospital care: a review of the literature

01 June 2012
Features
02 June 2012
Volume 4 · Issue 6

Abstract

Background:

Lactate has been identified as a useful marker of shock. Lactate can be measured in the pre-hospital environment rapidly and accurately.

Method:

A comprehensive literature search was conducted using a targeted search strategy. Additional literature was located through reference list searching and prior awareness by the authors. This identified a number of papers which were appraised for relevance. This appraisal identified 29 papers which were included in the review.

Conclusion:

Lactate has been shown to be measurable in the pre-hospital environment and to be prognostic of mortality. Lactate measurement needs to be linked to specific treatment algorithms with improved outcomes for patients in order to justify inclusion in pre-hospital practice.

This project stemmed from interest in two separate, yet connected, areas of paramedic practice, fluid resuscitation and sepsis. Separate investigations into these two areas identifed lactic acid, or lactate, as an area of interest. This review was conducted to identify the key literature on lactate measurement, and the implications for pre-hospital practice.

The research question was formed to be as inclusive as possible after initial investigations revealed lactate measurement has been studied in a range of clinical areas. It was decided to consider the range of possibilities for the use of lactate measurements in the pre-hospital environment. The use of pre-hospital lactate measurement has only recently become possible as technological advances have made the machines portable. Paramedic education has also developed to the point where paramedics can make clinical use of this type of information.

Lactate was frst described in the late 18th century by KW Scheele, a Swedish chemist. Lactate can be produced in all bodily tissue but is mainly produced by the skeletal muscles, skin, red blood cells, brain and intestines. Lactate is primarily metabolised in the liver and kidneys, with the average level being less than 2 mmol/l. Hyperlactatemia has classically been associated with anaerobic metabolism due to hypoxia. Recent research has linked elevated lactate levels with other diseases (Okorie and Dellinger, 2011).

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Lactate
Paramedic
Pre-hospital
Sepsis
Shock