title: Measurement of lactate in a prehospital setting is related to outcome.
abstract: OBJECTIVE
  We evaluated the relationship of lactate measured in a preclinical setting with outcome. Simultaneously, we evaluated the feasibility of implementing blood lactate measurement in a prehospital setting as part of a quality improvement project.
  
  
  METHODS
  Chart review of patients from whom serum lactate levels prospectively were obtained in a prehospital setting. Total population was divided into two groups, that is, a shock group and a non-shock group according to the predefined shock symptoms. The shock group was divided into two groups, that is, a lactate less than 4 mmol/l (subgroup I) and a lactate of at least 4 mmol/l (subgroup II).
  
  
  RESULTS
  In about 50% of possible cases, lactate was measured in the prehospital setting. Median lactate in subgroup I (n = 74) was 3.2 (1.5-3.9) mmol/l versus 5.0 (4.0-20.0) mmol/l in subgroup II (n = 61) (P<0.0001). Significant differences were found in length of stay in intensive care unit (P = 0.03) or hospital (P = 0.04) and mortality (subgroup I 12.2% vs. subgroup II 44.3%; P = 0.002). In normotensive shock patients showing a lactate of at least 4 mmol/l (n = 27), the mortality was higher compared with normotensive shock patients with a lactate less than 4 mmol/l (n = 31) (35 vs. 7%; P<0.001).
  
  
  CONCLUSIONS
  Implementation of lactate measurement in prehospital setting is feasible, and potentially clinical relevant. Lactate measured in a preclinical setting is related to outcome. Subsequent studies should evaluate whether treatment of shock patients based on prehospital lactate measurement will improve outcome.
authors.affiliation: Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, Groningen. paulvanbeest@yahoo.com
authors.forename: Paul A
authors.initials: PA
authors.lastname: van Beest
authors.forename: Peter Jan
authors.initials: PJ
authors.lastname: Mulder
authors.forename: Suparto Bambang
authors.initials: SB
authors.lastname: Oetomo
authors.forename: Bert
authors.initials: B
authors.lastname: van den Broek
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009426:Netherlands; D011787:Quality of Health Care; D012372:ROC Curve; D012769:Shock / Q000097:blood*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019344:Lactic Acid