Serum lactate serves as a surrogate marker for tissue hypoxia following traumatic injury, and may be used to guide resuscitation. The portable, lightweight nature of handheld point-of-care monitoring devices enables lactate values to be readily available in the pre-hospital environment, whether in land or air based evacuation modalities. The current review evaluates the utility of pre-hospital lactate measurement in the management of trauma patients.Methods
The published literature up to 06 August 2015 was searched using Medline and EMBASE using pre-defined criteria (English language, pre-hospital lactate measurement, trauma patients; excluding non-trauma/mixed patient groups). The Newcastle-Ottawa Scale was used to assess risk of bias of individual studies.Results
Of 857 non-duplicate articles of interest, 5 articles met the inclusion criteria, and included four cohort studies and one cross-sectional study. There were 2049 patients included in all studies.Key findings
▸ Pre-hospital lactate may be an independent prognostic marker of in-hospital mortality, multiple organ dysfunction, and requirement for transfusion or surgical intervention in trauma patients, particularly in blunt trauma.Key findings
▸ Pre-hospital lactate measurement may be more sensitive than systolic blood pressure in determining need for resuscitative care.Key findings
▸ Early lactate measurement may be particularly useful in the detection of occult hypotension, with elevated levels detectable within 30 minutes of injury.Key findings
▸ All current studies that investigate pre-hospital lactate were assessed as being at risk of bias.Conclusions
There is a paucity of evidence relating to pre-hospital lactate-guided management in trauma. From the limited literature, it seems that pre-hospital lactate may be a useful early tool in guiding the management of trauma patient resuscitation. Further prospective studies are required to elucidate the sensitivity and specificity of abnormal pre-hospital lactate values.