Enzymatic Debridement of Burns Reduces the Need for Blood Transfusions

Abstract

D ear Editor,Blood is a valuable resource that has specific guidance related to its safe and effective use (National Institute for Health and Care Excellence, 2015). In an effort to reduce the number of blood transfusions in our burn patients, we audited and changed our practice guidelines, resulting in a 100% reduction of unnecessary crossmatching investigations, thus increasing resources and reducing costs. Our previous practice guidelines recommended Group and Save (i.e., determining patient blood group [ABO and RhD] and screening for atypical antibodies) as a minimum for all burn patients undergoing operative treatment regardless of burn size. For patients with burns on more than 10% of their body requiring operative treatment, we routinely crossmatched two units of red blood cells and other blood products as considered necessary based on individual patient circumstances.Since implementing these guidelines, we have changed the way we treat burns. We now routinely perform enzymatic debridement (ED) of burns. Enzymatic debridement involves the application of a debriding enzyme in the form of a gel dressing. In many cases, ED can be performed outside of the operating room. The procedure is performed under local, regional, or general anesthesia as needed, and patients tolerate this procedure very well.We retrospectively reviewed 47 patients who were referred to our unit with burns on more than 10% of their total body surface area (TBSA). The patients were grouped according to the percentage of TBSA of their burns: 10%-20% (n = 31), 20%-30% (n = 10), and 30%-40% (n = 6). A total of 12 patients underwent ED, 32 underwent surgical debridement, and three were managed conservatively. Within the ED group, there were eight patients in the 10%-20% TBSA group and four patients in the 20%-30% TBSA group. None of these patients (n = 12) required a blood transfusion. Within the surgical debridement group, there were 20 patients in the 10%-20% TBSA group and

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®

“…Early studies, now empirically supported by long-term experiences due to an increasing popularity of ED, have already stated several advantages in comparison to classic surgery [69,[93][94][95]. While surgery, which is currently the most frequently used method for initial debridement and commonly still represents the SOC, undisputedly offers a sharp and radical excision of damaged structures with-frequently-nothing left but vital tissue on the one hand, it is still highly traumatic, requires OR facilities with anaesthesia, can cause extensive blood loss, and nearly always requires skin grafting on the other hand.…”

“…While surgery, which is currently the most frequently used method for initial debridement and commonly still represents the SOC, undisputedly offers a sharp and radical excision of damaged structures with-frequently-nothing left but vital tissue on the one hand, it is still highly traumatic, requires OR facilities with anaesthesia, can cause extensive blood loss, and nearly always requires skin grafting on the other hand. On the contrary, ED provides a more selective and aligned way for removal of eschar and, thus, avoids "collateral damage" to surrounding viable tissue, increasing the chances for conservative treatment options by leaving intact dermis with ability for spontaneous reepithelization [25,65,[95][96][97]. Eschar removal is perfectly aligned to the vital tissue, precisely revealing the actual burn depth even in complex heterogenous burn patterns or surgical challenging regions.…”

“…Eschar removal is perfectly aligned to the vital tissue, precisely revealing the actual burn depth even in complex heterogenous burn patterns or surgical challenging regions. Thereby, the use of ED can minimize blood loss and often obviates the need of skin grafting or, at least, reduces the area requiring surgical excision or transplantation, respectively [95,96]. As ED requires low technological needs, application can be feasible for bed side application depending on localization of burn wounds.…”

Enzymatic Debridement of Deep Thermal Burns in the Russian Federation: First Experience

“…Early use of this bromelain-based gel has been reported to result in rapid, selective, efficient, and safe (compared to standard treatment methods) eschar removal without damaging the uninjured dermis. At the same time, a decrease in the number of surgical interventions, blood loss, and even mortality rates have also been reported [ 19 , 20 , 22 , 30 , 31 ].…”