title: Prehospital point-of-care lactate following trauma: A systematic review.
abstract: Serum lactate serves as a surrogate marker for global tissue hypoxia following traumatic injury and has potential to guide resuscitation. Portable, handheld point-of-care monitoring devices enable lactate values to be readily available in the prehospital environment. The current review examines the utility of prehospital lactate (pLa) measurement in the management of trauma.
  
  
  
  MEDLINE and EMBASE databases were searched using predefined criteria (pLa measurement, trauma patients) until March 10, 2016. Studies were examined for lactate measurement as an intervention, prognostic indicator, and utilization in the guidance of goal-directed therapy. The Newcastle-Ottawa Scale was used to assess risk of bias, and quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation system. Data were unsuitable for meta-analysis and are presented in narrative form.
  
  
  
  Of 2,415 articles of interest, seven met the inclusion criteria, all of which were observational studies, including 2,085 trauma patients. Lactate sampling techniques, timings, and thresholds were heterogeneous. No studies used pLa to guide intervention. Elevated pLa may be an independent prognostic marker of critical illness in trauma patients, particularly in blunt trauma. Prehospital lactate measurement may be more sensitive than systolic blood pressure in determining need for resuscitative care. Early lactate measurement may be particularly useful in the detection of occult hypoperfusion, with elevated pLa detectable within 30 minutes of injury. All current studies were assessed as being of "low" or "very low" quality and were at risk of bias. Considerable logistical barriers to pLa measurement exist.
  
  
  
  Prehospital point-of-care lactate monitoring for trauma has been variably performed. There is a paucity of evidence relating to its use. The limited data available show feasibility and potential clinical utility, and further investigation is warranted to establish whether lactate might give meaningful guidance during prehospital triage and trauma patient resuscitation.
  
  
  
  Systematic review, level IV.
authors.affiliation: From the University of Birmingham, Birmingham, United Kingdom (C.T.L., D.N.N., M.J.M.); Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (D.N.N., N.C., M.J.M.); and NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom (D.N.N., M.J.M.).
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Lewis
authors.forename: David N
authors.initials: DN
authors.lastname: Naumann
authors.forename: Nick
authors.initials: N
authors.lastname: Crombie
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Midwinter
mesh_terms: D015415:Biomarkers / Q000097:blood*; D004632:Emergency Medical Services; D006801:Humans; D007773:Lactates / Q000097:blood*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011379:Prognosis; D014947:Wounds and Injuries / Q000097:blood*
chemical_list: D015415:Biomarkers; D007773:Lactates