The evolution of the Helsinki frostbite management protocol

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Radiology

Background:

• Severe frostbite injuries can lead to significant morbidity and loss of function, often requiring amputation.
• Traditional management of frostbite is conservative, but newer approaches involve early interventional angiography and fibrinolysis.
• This study evaluates a frostbite treatment protocol utilizing early intervention introduced three years prior.

Purpose of the Study:

• To evaluate the effectiveness of a new frostbite treatment protocol.
• To assess the outcomes of early interventional angiography and fibrinolysis in severe frostbite injuries.

Main Methods:

• Patients with frostbite underwent clinical and Doppler ultrasound examinations.
• Severe frostbite cases underwent angiography, followed by intra-arterial tissue plasminogen activator (tPA) and intravenous heparin if thrombosis was confirmed.
• Iloprost, a vasodilator, was administered intravenously in selected cases.

Main Results:

• Twenty patients were diagnosed with frostbite between 2013-2016; 14 had severe injuries.
• Ten patients underwent angiography, and nine received fibrinolytic treatment with tPA.
• The overall digital salvage rate was 74.8%, and the Hennepin tissue salvage rate was 81.1%; one patient developed a pseudoaneurysm.

Conclusions:

• Prompt referral to facilities with interventional radiology and 24/7 laboratory services is crucial.
• Combined use of tissue plasminogen activator (tPA) and iloprost may improve outcomes in severe frostbite.
• This approach offers a potential improvement over conservative management for severe frostbite.