Friday, June 17, 2011

Prehospital point of care lactate measurement

A study on in-the-field point of care lactate testing was discussed in a recent article in JEMS. Though the original study was a couple of years old it bears emphasis today given the poor rate of usage of the technique in the US. From the article:

The investigators conducted chart reviews on patients who had lactate levels measured prospectively, categorizing them into two groups: non-shock (lactate levels less than 4 mmol/L), and shock (lactate levels at least 4 mmol/L)...
The most staggering statistic was in-hospital mortality: the shock group had a 26.7% mortality rate compared with 1.2% for the non-shock group.

Staggering indeed. The benefit for patients is that the ER can be alerted from the field when a patient has a high lactate level and thereby get a head start in assembling the resources for EGDT (central line set up, etc), for which time is of the essence. In this respect it is analogous to the prehospital ECG in STEMI patients.

There are regulatory barriers in the US, well illustrative of the negative consequences of government intrusion, though they are not insurmountable. These are discussed in the article.

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