Mobiles Notfall-Labor in der präklinischen Notfallmedizin

Point-of-care (POC) lab investigations are an essential and quite common procedure for emergency and critical care, both in the emergency departement and ICU. Blood gas analysis as well as the results of haemoglobine and electrolytes may lead to live saving interventions. We investigated the value of POC lab in a prehospital setting on scene in a physician staffed emergency medical service. With approval by local ethics commission arterial blood samples were drawn in critical ill or injured patients (NACA5) on scene. POC lab was analyzed with the mobile Abbott i-STAT((R)) analyzer. The analysis included blood gas, haemoglobine and electrolytes. Outcome variables were the incidence of pathologic results, emergency interventions based on POC lab results and the correlation between PaCO2 and etCO(2) in mechanically ventilated patients. 33 patients were included with a total of 58 POC lab investigations (up to 3/patient) resulting in 682 measurements. Out of these 307 (45%) showed pathologic values. In 22 (66.7%) patients the acid-base-state and in 16 (48.5%) patients haemoglobine disagreed with standard values, in 8 (24.2%) patients hypokalaemia and in 6 (18.8%) hyperkalaemia occured. In total 32 (97%) patients had at least one pathologic result. In 18 (54.5%) patients POC lab lead to an urgent medical intervention. The difference PaCO2-etCO(2) in 21 mechanically ventilated patients was 17.2 +/- 12.9mmHg (mean +/- SD) with a maximum of 42.9mmHg. Point-of-care lab investigations on scene in the emergency medical service is suited to provide essential additional information for emergency treatment before admission to the hospital. The high and unpredictable difference of PaCO2-etCO(2) does not allow to adjust mechanical ventilation based on etCO(2) in these patients.