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Journal of Anaesthesia, Intensive Care and Emergency Medicine

Authors´ reply to Discernment of mortality predictors in patients with major injuries-direct trauma impact or systemic complications

Dear Editor

We wanted to thank Dobrić´ s interest in the article published in your journal a few months ago (Prognosis value of lactate in prehospital care as a predictor of mortality and high patients in trauma). The main objective of the article was to assess the utility of prehospital lactic acid (PLA) in predicting mortality at 2, 7 and 30 days (1). Dr. Dobrić makes some reflections that we would like to comment. First of all, one of the elements that we do not value in our work is the cause of death or the injury mechanism, we believe that with a sample size larger than ours, conclusions could be reached on these aspects, but our work is based on assessing the association of the PLA with any cause of death and the bad prognosis globally, as well as for any lesion mechanism which also allows us to extrapolate our results to any serious trauma; on the other hand, it is worth remembering that in many cases the cause of death of these patients it is difficult to know.

However, the article we present affects the evaluation of the traumatic patient in the prehospital field in which any tool that supposes an aid for the sanitary professionals must be taken into account. In that sense, we believe that our results guarantee the use of this biomarker as an aid in decision-making regarding the prognostic assessment of these patients (2-4). Focusing on the assessment of mortality within 2 days, it is obtained that the PLA has a predictive capacity to determine mortality from any cause or mechanism of 81% (95% CI 65.5-97.1%) which gives the test a large ability to predict poor prognosis; on the other hand, a PLA greater than, or equal to 5.9 mmol / mL has an LR (+) of 5.20 (95% CI 2.60-10.39) which means that this test globally can be considered as good (5), and also has an excellent negative predictive value of 95.6% (95% CI 89.1-98.3%). In any case, as indicated in the conclusions of our study, we believe that objective and structured evaluation should be the fundamental basis for the evaluation of critical patients and. in particular. of patients with severe trauma and that decision-making should not be based on the determination of the PLA only, but on a set of elements.

References

  1. Martin-Rodriguez F, Lopez-Izquierdo R. Prognostic value of lactate in prehospital care as a predictor of mortality and high-risk patients with trauma. Signa vitae 2019;15(1):59-61.
  2. Parsikia A, Bones K, Kaplan M, Strain J, Leung PS, Ortiz J, et al. The predictive value of initial serum lactate in trauma patients. Shock 2014; 42(3):199-204.
  3. Baxter J. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg 2016; 81(3):555-66.
  4. Lewis CT, Naumann DN, Crombie N, Midwinter MJ. Prehospital point-of-care lactate following trauma: A systematic review. J Trauma Acute Care Surg 2016; 81(4):748-55.
  5. Aznar-Oroval A, Marcheño-Alvaro A, García_lozano T, Sánchez-Yepes M. Likelihood ratio and Fagan’s nomogram: 2 basic tools for the rational use of clinical laboratory tests. Rev Calid Asist 2013;28(6):390-1 . doi: 10.1016/j.cali.2013.04.002. Epub 2013 Jun 17

Discernment of mortality predictors in patients with major injuries-direct trauma impact or systemic complications

Dear Editor,

I have recently read the article by Martin-Rodriguez and Lopez- Izquiedro ”Prognostic value of lactate in prehospital care as a predictor of mortality and high-risk patients with trauma”, where the authors analysed the prehospital lactate acid (PLA) serum level, and found it as good mortality predictor in patients who suffered major injury (MI) (1).

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Sudden cardiac arrest (SCA) is always an important topic, which catches physicians and health professionals’ attention. According to the Occupational Safety and Health Organization, 15% of workplace fatalities are due to SCA. While the incidence of SCA among employees in other Emergency services, i.e. firefighters (1) and police (2) has been described in the literature, there are no recorded data or published studies about SCA among medical staff employees in Emergency Medical Services (EMS). We describe the rare case SCA in emergency medical technicians (EMT) while in workplace.

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Major differences between conventional and compression-only cardiopulmonary resuscitation

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I read the article by Skulec et al. “Rescuer fatigue does not correlate to energy expenditure during simulated basic life support,” with great interest. (1) Although conventional cardiopulmonary resuscitation (CCPR) has been considered a standard CPR method since 1960, compression-only CPR (COCPR) has emerged as an alternative method to CCPR because of some evidence favoring COCPR. (2,3)

Therefore, numerous studies have attempted to determine whether COCPR could indeed improve the quality of CPR. A systematic review of these studies confirmed several obvious differences. (4)

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