Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK.
Department of Emergency Medicine, University Hospital Groningen, Groningen, the Netherlands.
BMC Emerg Med. 2020 Mar 11;20(1):18. doi: 10.1186/s12873-020-00314-1.
Point of care serum lactate measurement is emerging as an adjunct to prehospital clinical assessment and has the potential to guide triage and advanced treatment decision-making. In this study we aimed to assess which factors potentially affect prehospital lactate levels.
We performed a retrospective cohort study of all trauma patients attended by the Air Ambulance, Kent, Surrey & Sussex (AAKSS) between July 2017 and April 2018 in whom a pre-hospital lactate was measured. Lactate was measured before AAKSS treatments were commenced, but generally after prehospital treatment by ground ambulance crews was initiated. Primary endpoint of interest was the association of various patient- and treatment characteristics with prehospital lactate levels.
During the study period, lactate was measured in 156 trauma patients. Median lactate was 3.0 [2.0-4.1] mmol/l. Patients with an elevated lactate more often had deranged indices of end organ perfusion- and oxygenation (shock index 0.80 [0.58-1.03] vs 0.61 [0.40-0.82], p < 0.001, SpO 96 [89-100%] vs 98 [96-100%], p = 0.025). They more often suffered from head injuries (62% vs 41%, p = 0.008), and received less analgesia prior to arrival of the AAKSS team (51.6% vs 67.2%, p = 0.03). In multivariate analysis, indices of end organ perfusion- and oxygenation only explained 15% of the variation in lactate levels.
Prehospital lactate levels are not solely associated with indices of end organ perfusion- and oxygenation. Injury type, treatments given on scene and many other (unmeasured) factors likely play an important role as well. This should be taken into account when lactate is used in clinical algorithms to guide prehospital triage or treatment.
即时检测血清乳酸测量值正逐渐成为院前临床评估的辅助手段，并且有可能指导分诊和高级治疗决策。本研究旨在评估哪些因素可能会影响院前乳酸水平。
我们对 2017 年 7 月至 2018 年 4 月期间由肯特、萨里和苏塞克斯空中救护队（AAKSS）收治的所有创伤患者进行了回顾性队列研究，这些患者在院前进行了乳酸测量。乳酸是在 AAKSS 治疗开始前测量的，但通常是在地面救护人员开始院前治疗后。主要观察终点是各种患者和治疗特征与院前乳酸水平的关系。
在研究期间，对 156 名创伤患者进行了乳酸测量。中位数乳酸为 3.0[2.0-4.1]mmol/L。乳酸升高的患者更常伴有终末器官灌注和氧合的指标异常（休克指数 0.80[0.58-1.03]比 0.61[0.40-0.82]，p<0.001，SpO2 96[89-100%]比 98[96-100%]，p=0.025）。他们更常患有头部损伤（62%比 41%，p=0.008），并且在 AAKSS 团队到达之前接受的镇痛治疗更少（51.6%比 67.2%，p=0.03）。多变量分析表明，终末器官灌注和氧合的指标仅能解释乳酸水平变化的 15%。
院前乳酸水平不仅仅与终末器官灌注和氧合的指标相关。损伤类型、现场给予的治疗以及许多其他（未测量的）因素可能也起着重要作用。在使用乳酸指导院前分诊或治疗的临床算法时，应考虑到这一点。
