44 Point-of-care analysis of lactate from intraosseous samples during resuscitation

Aim Intraosseous (IO) access with power-driven devices has become a commonly used method of vascular access during cardiopulmonary resuscitation (CPR). Blood aspirated to confirm correct IO needle position could readily be available for point-of-care (POC) testing. The aim was to investigate how POC lactate levels of intraosseous blood reflect the lactate values in systemic circulation during VF and resuscitation in order to see whether POC IO samples could be used for clinical decision-making during CPR. Methods We conducted an experimental study comparing POC results of lactate from intraosseous, arterial and venous blood of 23 piglets undergoing induced cardiac arrest (VF) and CPR. All blood samples were analysed with i-STAT POC device and the results were compared using Bland-Altman method (ref 1). Results Prior to VF the IO lactate levels were similar to arterial and venous samples (bias [95% CI] between IO and arterial samples was 0.11 mmol/L [−0.02–0.24] and between IO and venous samples 0.03 mmol/L [−0.25–0.31]). Five minutes after onset of VF, intraosseous lactate levels had increased more than arterial and venous values (bias 3.76 mmol/L [1.93–5.59] and 3.52 mmol/L [1.41–5.64] respectively). Five minutes after initiation of CPR with an automatic CPR device (LucasTM) the difference diminished (bias 0.81 mmol/L, [−0.31–1.93] and 1.50 mmol/L [0.07–2.92]). Conclusion Intraosseous lactate values showed good agreement with arterial and venous values before cardiac arrest, but IO values were clearly higher during VF and CPR. During resuscitation IO lactate values seem to represent better the metabolic state at tissue level than arterial or venous lactate. Reference Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet1986;1:307–10 Conflict of interest None declared. Funding None declared.