LACTEL
Trial question
What is the role of resuscitation strategy using CO₂-O2-derived indices in patients with acute circulatory failure?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
34.0% female
66.0% male
N = 179
179 patients (60 female, 119 male).
Inclusion criteria: adult patients with acute circulatory failure and arterial blood lactate levels ≥ 3 mmol/L.
Key exclusion criteria: no affiliation with health insurance system; under legal protection; pregnancy or lactation; mechanical support.
Interventions
N=89 CO₂-O2-derived algorithm-based treatment (use of central venous and arterial blood gas analysis for CO₂-O2-derived indices measurements).
N=90 standard clinical practice (management of hemodynamics following standard of care).
Primary outcome
Lactate clearance > 10% within 2 hours
43.8%
50%
50.0 %
37.5 %
25.0 %
12.5 %
0.0 %
CO2-O2-derived algorithm-based
treatment
Standard clinical
practice
No significant
difference ↔
No significant difference in lactate clearance > 10% within 2 hours (43.8% vs. 50%; ARD -6.2, 95% CI -23.69 to 11.29).
Secondary outcomes
No significant difference in SOFA score (7 points vs. 6 points; AD 1 points, 95% CI -4.19 to 6.19).
No significant difference in death at day 28 (44.9% vs. 33.3%; AD 11.6%, 95% CI -4.18 to 27.38).
No significant difference in length of hospital stay (10 days vs. 11 days; AD -1 days, 95% CI -3.8 to 1.8).
Conclusion
In adult patients with acute circulatory failure and arterial blood lactate levels ≥ 3 mmol/L, CO₂-O2-derived algorithm-based treatment was not superior to standard clinical practice with respect to lactate clearance > 10% within 2 hours.
Reference
Pierre-Grégoire Guinot, Corentin Evezard, Maxime Nguyen et al. Treatment of Acute Circulatory Failure Based on CO2-O2-Derived Indices: the Lactel randomized multicentre study. Chest. 2025 Apr;167(4):1068-1078.
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