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Is prehospital lactate testing useful in improving clinical assessment?

02 June 2019
Volume 11 · Issue 6



Lactate devices offer the potential for paramedics to improve patient triage and escalation of care for specific presentations. There is also scope to improve existing prehospital tools by including lactate measurement.


A literature search was conducted using the Medline, CINAHL, Academic Search Premier, Sciencedirect and Scopus databases.


Acquiring prehospital lactate measurement in trauma settings improved triage and recognition of the need for critical care. Within a medical setting, studies offered mixed results in relating prehospital lactate measurement to diagnosis, escalating treatments and mortality. The accuracy of prehospital lactate measurements acquired varies, which could impact decision making.


Prehospital lactate thresholds could aid decision making, although the literature is limited and evidence varies. Lactate values of ≥4 mmol/litre in medical and ≥2.5 mmol/litre in trauma patients could signify that care should be escalated to an appropriate facility, and that resuscitative measures should be initiated, particularly with sepsis, as reflected by standardised lactate values that guide treatment in hospitals. Similarly, a lactate value of <2 mmol/litre could mean de-escalating care into the community, although further research is warranted on this.

An indication of critical illness is an imbalance in oxygen delivery to vital organs, resulting in hypoperfusion (Odom and Talmor, 2016). Because of hypoperfusion, anaerobic metabolic demand is increased, resulting in an increase in blood lactate levels (Soller et al, 2014). Elevated blood lactate indicates an increased risk of mortality, even in individuals who appear physiologically stable (Vincent et al, 2016).

In hospitals, lactate levels are commonly measured to assess adequacy of resuscitation, and are a key marker for evaluating patients with sepsis, where a lactate level ≥4 mmol/litre indicates septic shock (Casserly et al, 2015), and is a guideline for fluid resuscitation (National Institute for Health and Care Excellence (NICE), 2016). Similarly, it has been identified that lactate is useful in predicting mortality in trauma (Colon-Franco et al, 2017). Da Costa et al (2017) recognised that early monitoring of lactate levels in trauma patients identifies the adequacy of perfusion and the progression of organ failure, whereby lactate increments of 1 mmol/litre show increases in mortality.

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