A Protocolized Intravenous Epoprostenol Pathway for Frostbite: A Canadian Burn Centre Quality Improvement and...

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Pharmacology

Background:

• Severe frostbite causes microvascular injury and potential tissue loss.
• Current treatments include rewarming, antithromboxanes, and prostacyclin analogues like iloprost.
• Access to iloprost can be limited in certain regions.

Purpose of the Study:

• To develop and evaluate a monitored intravenous epoprostenol pathway for severe frostbite (Cauchy grade 2-4).
• To assess the feasibility, safety, and potential efficacy of this pathway in a Canadian setting.

Main Methods:

• Retrospective evaluation of 23 patients treated with a protocol including rapid rewarming, grading, antithromboxane therapy, and intravenous epoprostenol.
• The pathway involved specific eligibility criteria, dose titration, physiological monitoring, and multidisciplinary care.
• Data collected on digit preservation, treatment duration, adverse effects, and patient outcomes.

Main Results:

• 153 of 216 affected digits were preserved (62/65 grade 2, 74/100 grade 3, 7/41 grade 4).
• Twelve patients avoided amputation entirely.
• Epoprostenol was generally well-tolerated, with manageable adverse effects in nine patients; no serious drug-attributed events were recorded.

Conclusions:

• Protocol-guided intravenous epoprostenol is a feasible and generally well-tolerated treatment for severe frostbite.
• The findings suggest potential for digit salvage but require further investigation.
• This pathway provides a valuable alternative for frostbite management where iloprost access is delayed.