Preservation of Traumatic Completely Amputated or Avulsed Body Parts in the First Aid Setting: A Scoping Review

Traumatic amputations or avulsions are physically and emotionally devastating events that may result in long-term disability. Despite increasing global incidence, optimal prehospital preservation strategies are underutilized, reducing the likelihood of successful replantation. This scoping review was performed as part of the International Liaison Committee on Resuscitation's (ILCOR) continuous evidence evaluation process to update the 2025 ILCOR Consensus on Science with Treatment Recommendations. Our aim was to scope the research literature on prehospital preservation methods used for amputated or avulsed body parts and their impact on replantation success. We searched PubMed, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and the International Clinical Trials Registry Platform from inception through February 26, 2025, for studies comparing approaches to preserve completely amputated or avulsed body parts in the out-of-hospital setting. Data on first aid intervention characteristics, ischemic times, and replantation outcomes were summarized. We concurrently reviewed first aid guidelines and participant manuals from global organizations to assess strategies taught for the management and storage of amputated body parts. Thirty-nine publications were included in the final analysis, with the majority (73%) being case reports. No randomized controlled trials were identified that directly compared different cold storage techniques (e.g., ice-water immersion vs. dry cold storage). Key findings emphasized the importance of cooling amputated parts after wrapping with saline-moistened gauze and double-bagging to extend ischemic tolerance. This review identified an extensive evidence base suggesting that nonfreezing cold preservation of amputated or avulsed body parts as soon as possible after injury is associated with survival of replantation and improved function and cosmesis. Training first aid providers, standardizing prehospital protocols, and increasing public awareness could enhance patient outcomes and expand access to replantation globally. However, additional studies are needed to identify alternative means of sustained cold storage of amputated body parts, especially in low-resource first aid settings.