Implementation of Real-Time Point-of-Care Lactate During Resuscitation of Non Traumatic Cardiac Arrest in the Emergency Department: A Narrative Review of the Literature and Meta-analysis
Abstract:
Background: Blood lactate reflects the degree of systemic hypoperfusion and oxygen debt, serving as a dynamic marker of cellular metabolism during cardiac arrest. Point-of-care (POC) lactate measurement provides rapid bedside results that may support decision-making in emergency resuscitation. However, the real-time implementation of POC lactate testing during active cardiopulmonary resuscitation (CPR) for non-traumatic cardiac arrest (NTCA) remains poorly characterized.
Objective: To review and synthesize current evidence (2015–2025) regarding the analytical performance, prognostic value, and feasibility of real-time POC lactate measurement during CPR in the emergency department (ED).
Methods: A narrative literature review was conducted using PubMed, Scopus, and ScienceDirect, including human studies and systematic reviews published in English over the last ten years evaluating lactate kinetics, POC accuracy, and prognostic outcomes in cardiac arrest, shock, and other critical conditions.
Results: POC lactate demonstrates high analytical concordance with laboratory assays and markedly reduced turnaround times (median 5 min vs >60 min) [1]. Elevated lactate measured during CPR is independently associated with reduced 1-month survival after out-of-hospital cardiac arrest (OHCA) [2]. Post-ROSC lactate levels and incomplete clearance predict poor neurologic recovery and in-hospital mortality [3–6]. Admission lactate > 14 mmol/L in refractory OHCA candidates for extracorporeal CPR (ECPR) shows high specificity for adverse outcomes [7–9]. Yet, the prognostic thresholds and integration of real-time data into resuscitation algorithms remain undefined.
Conclusions: The technological feasibility of real-time POC lactate testing is well established, and its prognostic relevance is biologically and clinically plausible. Nonetheless, evidence directly linking in-CPR POC lactate monitoring to improved outcomes is lacking. Prospective ED-based trials should evaluate workflow safety, sampling intervals, and decision thresholds to determine whether lactate-guided resuscitation enhances return of spontaneous circulation (ROSC), survival, and neurological outcomes. Further prospective studies are required to define thresholds, timing, and action pathways that demonstrate a causal benefit on outcomes.
