Prehospital point-of-care lactate following trauma: a systematic review.

Background: Serum lactate serves as a surrogate marker for global tissue hypoxia following traumatic injury, and has potential to guide resuscitation. Portable, handheld point-of-care monitoring devices enable lactate values to be readily available in the prehospital environment. The current review examines the utility of prehospital lactate (pLa) measurement in the management of trauma. Methods: Medline and Embase databases were searched using pre-defined criteria (prehospital lactate measurement, trauma patients) until 10 March 2016. Studies were examined for lactate measurement as an intervention, prognostic indicator, and utilisation in the guidance of goal-directed therapy. The Newcastle-Ottawa Scale was used to assess risk of bias, and quality of evidence evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation system. Data were unsuitable for meta-analysis and are presented in narrative form. Results: Of 2415 articles of interest, 7 met the inclusion criteria, all of which were observational studies, including 2085 trauma patients. Lactate sampling techniques, timings and thresholds were heterogeneous. No studies used pLa to guide intervention. Elevated pLa may be an independent prognostic marker of critical illness in trauma patients, particularly in blunt trauma. pLa 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 hypoperfusion, with elevated pLa detectable within 30 minutes of injury. All current studies were assessed as being of "low" or "very low" quality, and were at risk of bias. Considerable logistical barriers to pLa measurement exist. Conclusions: Prehospital point-of-care lactate monitoring for trauma has been variably performed. There is a paucity of evidence relating to its use. The limited data available show feasibility and potential clinical utility, and further investigation is warranted to establish whether lactate might give meaningful guidance during prehospital triage and trauma patient resuscitation. Level of Evidence: Systematic review, level IV. (C) 2016 Lippincott Williams & Wilkins, Inc.

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