MODERATE RECOMMENDATION One high quality study (Mitas, 2014) of patients with acute limb ischemia from femoral artery embolism reported serial lactate measurements taken from the femoral vein just before and at several time points following limb revascularization. The results showed a strong relationship between the difference in blood lactate concentration immediately before and after revascularization and the reference standard of fasciotomy (which was performed based on clinical findings of new sensorimotor deficits and/or intracompartment pressure greater than 30 mmHg). This strong relationship to the reference standard held true at any threshold of blood lactate level between 1 and 3 mmol/L. Although the pressure criterion used could be considered an overly conservative indication for fasciotomy, the findings show that compartment syndrome is more likely when a more profound metabolic disturbance is present. It is important to recognize that this diagnostic approach is only applied ACS occurring in non-trauma patients with acute lower limb ischemia from femoral artery embolism.
FUTURE RESEARCH
Future research examining the sensitivity and specificity of biomarkers compared to an appropriate reference standard (e.g. validated and/or comprehensive clinical and pressure diagnosis) in a population of patients suspected of ACS would be invaluable.