1 Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts USA.
2 Department of Emergency Medicine, Louisiana State University, Baton Rouge, Louisiana USA.
Prehosp Disaster Med. 2014 Apr;29(2):200-3. doi: 10.1017/S1049023X13009254. Epub 2014 Mar 19.
Lactate measurement has been used to identify critical medical illness and initiate early treatment strategies. The prehospital environment offers an opportunity for very early identification of critical illness and commencement of care.
The investigators hypothesized that point-of-care lactate measurement in the prehospital aeromedical environment would: (1) identify medical patients with high mortality; (2) influence fluid, transfusion, and intubation; and (3) increase early central venous catheter (CVC) placement.
Critically ill, medical, nontrauma patients who were transported from September 2007 through February 2009 by University of Massachusetts (UMass) Memorial LifeFlight, a university-based emergency medical helicopter service, were eligible for enrollment. Patients were prospectively randomized to receive a fingerstick whole-blood lactate measurement on an alternate-day schedule. Flight crews were not blinded to results. Flight crews were asked to inform the receiving attending physician of the results. The primary endpoint was the ability of a high, prehospital lactate value [> 4 millimoles per liter (mmol/L)] to identify mortality. Secondary endpoints included differences in post-transport fluid, transfusion, and intubation, and decrease in time to central venous catheter (CVC) placement. Categorical variables were compared between groups by Fisher's Exact Test, and continuous variables were compared by t-test.
Patients (N = 59) were well matched for age, gender, and acuity. In the lactate cohort (n = 20), mean lactate was 7 mmol/L [Standard error of the mean, SEM = 1]. Initial analysis revealed that prehospital lactate levels of ≥ 4 mmol/L did show a trend toward higher mortality with an odds ratio of 2.1 (95% CI, 0.3-13.8). Secondary endpoints did not show a statistically significant change in management between the lactate and non lactate groups. There was a trend toward decreased time to post-transport CVC in the non lactate faction.
Prehospital aeromedical point-of-care lactate measurement levels ≥ 4 mmol/L may help stratify mortality. Further investigation is needed, as this is a small, limited study. The initial analysis did not find a significant change in post-transport management.
乳酸测量已被用于识别严重的医学疾病并启动早期治疗策略。在院前环境中，有机会非常早期地识别严重疾病并开始治疗。
研究人员假设，在院前航空医疗环境中进行即时乳酸测量将：（1）识别高死亡率的医疗患者；（2）影响液体、输血和插管；（3）增加早期中心静脉导管（CVC）放置。
符合条件的危重、医疗、非创伤患者于 2007 年 9 月至 2009 年 2 月期间通过马萨诸塞大学（UMass）纪念生命飞行（一家大学紧急医疗直升机服务机构）进行转运，他们有资格入组。患者前瞻性随机接受隔日指尖全血乳酸测量。机组人员未对结果进行盲法处理。机组人员被要求将结果告知接收主治医生。主要终点是高院前乳酸值[>4 毫摩尔/升（mmol/L）]识别死亡率的能力。次要终点包括转运后液体、输血和插管的差异，以及中央静脉导管（CVC）放置时间的减少。使用 Fisher 精确检验比较组间的分类变量，使用 t 检验比较连续变量。
患者（N=59）在年龄、性别和疾病严重程度方面匹配良好。在乳酸组（n=20）中，平均乳酸值为 7mmol/L[均数标准差（SEM）=1]。初步分析表明，院前乳酸水平≥4mmol/L 确实显示出较高死亡率的趋势，优势比为 2.1（95%可信区间，0.3-13.8）。次要终点显示乳酸组和非乳酸组之间的管理无统计学显著差异。非乳酸组的 CVC 转运后时间呈下降趋势。
院前航空医疗即时乳酸测量水平≥4mmol/L 可能有助于分层死亡率。这是一项小型、有限的研究，需要进一步研究。初步分析并未发现转运后管理的显著变化。
