Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone
<i>Background and Objectives</i>: 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 availabi...
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MDPI AG
2021-11-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/11/1284 |
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| author | Marie-Anne Magnan Angèle Gayet-Ageron Pierre Louge Frederic Champly Thierry Joffre Christian Lovis Rodrigue Pignel |
| author_facet | Marie-Anne Magnan Angèle Gayet-Ageron Pierre Louge Frederic Champly Thierry Joffre Christian Lovis Rodrigue Pignel |
| author_sort | Marie-Anne Magnan |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: 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. <i>Materials and Methods:</i> 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. <i>Results</i>: 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, <i>p</i> = 0.006); the odds ratio was significantly higher by 45-fold (95%CI: 6-335, <i>p</i> < 0.001) in the prospective cohort compared to the historical cohort after adjustment for age and delay between signs of freezing and treatment start. <i>Conclusions</i>: 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. |
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| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T05:17:31Z |
| publishDate | 2021-11-01 |
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| series | Medicina |
| spelling | doaj.art-21c5fd27f17d4715b54944ffc7b6173c2023-11-23T00:18:32ZengMDPI AGMedicina1010-660X1648-91442021-11-015711128410.3390/medicina57111284Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost AloneMarie-Anne Magnan0Angèle Gayet-Ageron1Pierre Louge2Frederic Champly3Thierry Joffre4Christian Lovis5Rodrigue Pignel6Hyperbaric Medicine Unit, Department of Acute Medicine, University Hospitals of Geneva, 1205 Geneva, SwitzerlandCRC & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva & University Hospitals of Geneva, 1205 Geneva, SwitzerlandHyperbaric Medicine Unit, Department of Acute Medicine, University Hospitals of Geneva, 1205 Geneva, SwitzerlandEmergency Department of Mont-Blanc Hospitals, The Mont-Blanc Hospitals, 74700 Chamonix-Sallanches, FranceHyperbaric Center, Hospices Civils de Lyon, University Hospitals of Lyon-1, 69003 Lyon, FranceDivision of Medical Information Sciences, Geneva University Hospitals and University of Geneva, 1205 Geneva, SwitzerlandHyperbaric Medicine Unit, Department of Acute Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland<i>Background and Objectives</i>: 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. <i>Materials and Methods:</i> 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. <i>Results</i>: 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, <i>p</i> = 0.006); the odds ratio was significantly higher by 45-fold (95%CI: 6-335, <i>p</i> < 0.001) in the prospective cohort compared to the historical cohort after adjustment for age and delay between signs of freezing and treatment start. <i>Conclusions</i>: 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.https://www.mdpi.com/1648-9144/57/11/1284frostbiteclassificationhyperbaric oxygen therapycold diseaseprognosisamputation |
| spellingShingle | Marie-Anne Magnan Angèle Gayet-Ageron Pierre Louge Frederic Champly Thierry Joffre Christian Lovis Rodrigue Pignel Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone Medicina frostbite classification hyperbaric oxygen therapy cold disease prognosis amputation |
| title | Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone |
| title_full | Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone |
| title_fullStr | Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone |
| title_full_unstemmed | Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone |
| title_short | Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone |
| title_sort | hyperbaric oxygen therapy with iloprost improves digit salvage in severe frostbite compared to iloprost alone |
| topic | frostbite classification hyperbaric oxygen therapy cold disease prognosis amputation |
| url | https://www.mdpi.com/1648-9144/57/11/1284 |
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