Abstract
Background and Objectives: Frostbite is a freezing injury that can lead to amputation. Current treatments include tissue rewarming followed by thrombolytic or vasodilators. Hyperbaric oxygen (HBO) therapy might decrease the rate of amputation by increasing cellular oxygen availability to the damaged tissues. The SOS-Frostbite study was implemented in a cross-border program among the hyperbaric centers of Geneva, Lyon, and the Mont-Blanc hospitals. The objective was to assess the efficacy of HBO + iloprost among patients with severe frostbite. Materials and Methods: We conducted a multicenter prospective single-arm study from 2013 to 2019. All patients received early HBO in addition to standard care with iloprost. Outcomes were compared to a historical cohort in which all patients received iloprost alone between 2000 and 2012. Inclusion criteria were stage 3 or 4 frostbite and initiation of medical care <72 h from frostbite injury. Outcomes were the number of preserved segments and the rate of amputated segments. Results: Thirty patients from the historical cohort were eligible and satisfied the inclusion criteria, and 28 patients were prospectively included. The number of preserved segments per patient was significantly higher in the prospective cohort (mean 13 ± SD, 10) compared to the historical group (6 ± 5, p = 0.006); the odds ratio was significantly higher by 45-fold (95%CI: 6-335, p < 0.001) in the prospective cohort compared to the historical cohort after adjustment for age and delay between signs of freezing and treatment start. Conclusions: This study demonstrates that the combination of HBO and iloprost was associated with higher benefit in patients with severe frostbite. The number of preserved segments was two-fold higher in the prospective cohort compared to the historical group (mean of 13 preserved segments vs. 6), and the reduction of amputation was greater in patients treated by HBO + iloprost compared with the iloprost only.
Highlights
Frostbite is an injury caused by freezing of the skin and underlying tissues
The prospective cohort: Thirty-nine patients with grade 3 or 4 frostbite were treated from 2013 to 2019 with the SOS-Frostbite protocol; 11 patients were excluded because medical care delay was over 72 h from frostbite injury or the treatment protocol was interrupted or changed
We showed that Hyperbaric oxygen (HBO) plus standard care including iloprost significantly reduced the amputation risk even over 48h from frostbite injury
Summary
Frostbite is an injury caused by freezing of the skin and underlying tissues. Severe frostbite is a relatively uncommon event that can lead to early arthritis, tissue loss, or amputation. There is a vascular stasis with a prothrombotic environment (hypoxia and acidosis), interstitial edema, and ischemia–reperfusion injuries It leads to the destruction of microcirculation and cell death [2,3]. The Cauchy classification defines four grades that predict the amputation risk after rapid thawing in warm water when there is no targeted frostbite care [3]. It is based on the extent of the initial cyanotic lesion. The number of preserved segments was two-fold higher in the prospective cohort compared to the historical group (mean of 13 preserved segments vs 6), and the reduction of amputation was greater in patients treated by HBO + iloprost compared with the iloprost only
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