Case Report of Frostbite with Delay in Evacuation: Field Use of Iloprost Might Have Improved the Outcome

Abstract

Irarrázaval, Sebastián, Pablo Besa, Emmanuel Cauchy, Prativa Pandey, and Jorge Vergara. Case report of frostbite with delay in evacuation: field use of iloprost might have improved the outcome. High Alt Med Biol 00:000-000, 2018. -Frostbite is a common injury in high altitude medicine. Intravenous vasodilators have a proven efficacy and, recently, have been proposed as a safe outpatient treatment. Nevertheless, the lack of availability and consequently delayed application of this treatment option can result in poor clinical outcomes for patients. We present the case of a 60-year-old Chilean man with severe frostbite injuries suffered while climbing Mount Everest. The patient was initially given field treatment to the extent permitted by conditions and consensus guidelines. Unfortunately, advanced management was delayed, with iloprost administered 75 hours after the initial injury. The patient also underwent 5 days of hyperbaric and analgesic/antibiotic therapies. An early bone scan predicted a poor clinical outcome, and five of the patient's fingers, between both hands, were incompletely amputated. We present this case to exemplify the importance of advanced in-field management of frostbite injuries.

Iloprost for the treatment of frostbite: a scoping review

“…However, the rewarming method was not consistently described. Eight studies reported rapid rewarming with immersion in hot water [ 41 , 42 , 44–46 , 49 , 52 , 54 ]. Others simply stated that rewarming had occurred.…”

“…Hyperbaric oxygen therapy (HBOT) was used in six studies [ 42 , 43 , 48 , 49 , 54 , 55 ]. Many studies did not describe their HBOT protocol beyond the number of days they used the treatment for.…”

“…Some studies presented pictures of wound appearance or described digit and limb function on follow-up [ 38–40 , 42 , 45–47 , 49–51 , 55 ]. There was often limited information on potential chronic issues in patients who avoided amputation such as vasomotor disturbances, neuropathic and nociceptive pain or damage to skeletal structures [ 60 ].…”

“…Another patient with Grade 4 and Grade 2 to 3 injuries to their right hand and left foot, respectively, required a right palm and four left-toe amputations. Another case report by Irarrazaval et al described a patient with Grades 2 and 3 frostbite who required some degree of amputation for each digit despite iloprost treatment [ 49 ]. One publication described the case of an unfortunate elderly patient with Cold Agglutinin Disease and Raynaud’s who presented seven days after cold exposure with extensive cyanosis to feet and hands [ 51 ].…”

Can iloprost be used for treatment of cold weather injury at the point of wounding in a forward operating environment? A literature review

“…Perhaps, the most significant case report yielded as part of the search is that of a single case described by Irarrazaval et al [ 26 ]. After a challenging evacuation, a patient was treated with iloprost 75 h after initial symptoms.…”