Abstract 3: Prehospital Lactate for Identification of the Need for Resuscitative Care in Trauma Patients Transported by Air
Background: Prehospital point-of-care lactate (P-LAC) is strongly associated with the need for resuscitative care (RC) following ground transport. Patients transported by air differ in that they have higher injury severity, longer transport times, and more prehospital life saving interventions.
Objective: To compare P-LAC to systolic blood pressure (SBP) for predicting the need for RC in trauma patients with 70 < SBP ≤ 100 mmHg who are transported by air.
Methods: Prospective observational study at 11 sites of the Resuscitation Outcomes Consortium. Blinded P-LAC values were collected following IV placement in patients with SBP ≤ 100 mmHg who were transported by air to a level I or II trauma center. The primary endpoint was the need for RC, defined as any of the following within 6 hours of emergency department arrival: blood transfusion ≥ 5 units, thoracotomy, laparotomy, pelvic fixation, embolization or death. The sensitivity for RC of P-LAC ≥ 2.3 mmol/L was compared to that of SBP ≤ 90 mmHg using McNemar’s test, where the P-LAC rule was selected such that its specificity (41%) was equivalent to that of SBP ≤ 90. The areas under the receiver operating characteristic curves (AUCs) of P-LAC and SBP were also compared.
Results: Of 218 patients with 70 < SBP ≤ 100 mmHg transported by air between February, 2011 to November, 2013, there were 35 (16%) deaths and 92 (42%) requiring RC. Median P-LAC was 3.6 mmol/L (IQR 2.3-5.8) in those requiring RC and 2.5 (1.9-3.7) in those who did not. The sensitivity of P-LAC ≥ 2.3 mmol/L for RC was 76% (CI 66-84%) compared to 52% (42-63%) for SBP ≤ 90 mmHg (p=0.02). P-LAC AUC was 0.66 (CI 0.58-0.73) while that of SBP was 0.49 (0.42-0.57) (p=0.006). The sensitivity of lactate for RC was greater among patients who had received less prehospital fluid and had a shorter time to P- LAC testing, but this difference was not statistically significant.
Conclusion: P-LAC is superior to SBP in predicting the need for RC in trauma patients transported by air with 70 < SBP ≤ 100 mmHg.
Author Disclosures: F.X. Guyette: None. E. Meier: None. J. Kerby: None. C. Williams: None. R. Schlamp: None. R. Wand: None. J. McMullan: None. D. Kannas: None. S. May: None. M. Daya: None. I. Ibrahim-Zada: None. M. Moffat: None. K. Brasel: None. R. Colella: None. T. Fabian: None. J. Mena-Munoz: None. E. Bulger: None. L. Rokowski: None. S. Brennan: None. R. Whitford: None. G. Sopko: None. D. Hoyt: None.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.