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Time to Thrombolytics and Tissue Salvage: Assessing Response Following Severe Frostbite Injury
Rachel M Nygaard1, Emily Colonna1, Rediat A Tilahun1
1Department of Surgery, Hennepin County Medical Center, Hennepin Healthcare, Minneapolis, MN 55415, United States.
Summary
Timely thrombolytic therapy for severe frostbite reduces amputation risk. This study categorizes patient responses, showing early treatment and imaging predict better outcomes, even beyond standard windows.
Area of Science:
- Medical research
- Trauma care
- Vascular surgery
Background:
- Severe frostbite injuries frequently lead to amputation, necessitating effective tissue-sparing treatments.
- Thrombolytic therapy is a critical intervention to mitigate tissue loss in frostbite cases.
Purpose of the Study:
- To evaluate factors influencing thrombolytic therapy effectiveness in severe frostbite.
- To categorize patient responses to thrombolytics (full, partial, non-responders) for nuanced outcome assessment.
- To correlate perfusion imaging and amputation levels with thrombolytic treatment efficacy.
Main Methods:
- Retrospective review of a prospectively maintained frostbite database.
- Inclusion criteria: patients with post-rewarming perfusion deficits (Tc99 scans) receiving intravenous thrombolytics.
- Outcome measures: post-treatment perfusion imaging and amputation level; patient response categorized.
Main Results:
- Surgical outcomes: 71% full, 23.7% partial, 5.3% non-responders. Non-response linked to delayed thrombolytics (median 10 hrs), larger deficits, and infection.
- Imaging outcomes (n=93): 28% full, 57% partial, 15% non-responders. Full imaging responders had no amputations.
- Partial (37.7%) and non-responders (42.9%) on imaging had higher amputation rates. Timely thrombolytics and treatment outside standard windows showed benefits.
Conclusions:
- Categorizing thrombolytic response using imaging and surgical outcomes provides critical insights into treatment efficacy.
- Early administration of thrombolytics is crucial for optimal outcomes in severe frostbite.
- This study highlights the potential benefits of thrombolytic therapy even when administered outside traditional timeframes.
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