Successful Delayed Hyperbaric Oxygen Therapy and Iloprost Treatment on Severe Frostbite at High Altitude

Magnan, Marie-Anne; Gelsomino, Marco; Louge, Pierre; Pignel, Rodrigue

doi:10.1089/ham.2021.0172

Cited by 2 publications

(5 citation statements)

References 10 publications

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“…Unfractionated heparin (UFH) and low molecular weight heparins (LMWH) were also frequently used in the studies included in this review. As described previously, evidence supports the use of heparin as adjunctive therapy in thrombolytic protocols, but heparin or enoxaparin/dalteparin have been used in conjunction with iloprost alone in eight of the studies included in this review [ 21 , 38 , 39 , 42 , 43 , 48 , 50 , 55 ]. Whether UFH or LMWH offer additional benefit when combined with iloprost requires further investigation.…”

Section: Discussionmentioning

confidence: 91%

“…The largest studies published were Cauchy et al 2016 ( N = 78), Magnan et al 2022 ( N = 58), Cauchy et al 2011 ( N = 32), Crooks et al 2022 ( N = 26) and Poole et al 2021 ( N = 22). There exists the possibility of cases overlap between the different publications owing to the fact that four groups produced two cases series each (Cauchy et al, Gorjanc et al, Poole et al and Magnan et al) [ 41 , 42 , 44 , 45 , 48 , 52 , 54 , 55 ]. At most, the overlap would produce redundancy in 37 patients.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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 ].…”

Section: Discussionmentioning

confidence: 99%

“…One patient with a poor outcome likely experienced a freeze-thaw-refreeze injury. Other authors observed iloprost benefit despite delayed initiation of iloprost 70-h post injury [ 55 ] and five-day post-rewarming [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

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Iloprost for the treatment of frostbite: a scoping review

Gauthier

Morris-Janzen

Poole

2023

International Journal of Circumpolar Health

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We performed a scoping review to identify the extent of the literature describing the use of iloprost in the treatment of frostbite. Iloprost is a stable synthetic analog of prostaglandin I 2 . As a potent inhibitor of platelet aggregation and vasodilator, it has been used to address the post-rewarming reperfusion injury in frostbite. The search using iloprost and frostbite as key words and MeSH terms yielded 200 articles. We included in our review the literature examining iloprost for the treatment of frostbite in humans in the form of primary research, conference proceedings and abstracts. Twenty studies published from 1994 to 2022 were selected for analysis. The majority were retrospective case series consisting of a homogeneous population of mountain sport enthusiasts. A total of 254 patients and over 1000 frostbitten digits were included among the 20 studies. The larger case series demonstrated a decrease in amputation rates relative to untreated patients. Primary gaps in the literature include a paucity of randomised trials and relatively limited study populations to date. While the case evidence is promising, a multi-centre collaboration would be crucial to adequately power prospective randomised studies to definitively determine if iloprost has a role in the treatment of frostbite.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Iloprost for the treatment of frostbite: a scoping review

Gauthier

Morris-Janzen

Poole

2023

International Journal of Circumpolar Health

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Frostbite treatment: a systematic review with meta-analyses

Regli,

Oberhammer,

Zafren

et al. 2023

Scand J Trauma Resusc Emerg Med

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Introduction Our objective was to perform a systematic review of the outcomes of various frostbite treatments to determine which treatments are effective. We also planned to perform meta-analyses of the outcomes of individual treatments for which suitable data were available. Main Body We performed a systematic review and meta-analyses in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Cochrane Trials, and EMBase to identify primary references from January 1, 1900, to June 18, 2022. After eliminating duplicates, we screened abstracts to identify eligible studies containing information on treatment and outcomes of Grade 2 to 4 frostbite. We performed meta-analyses of groups of articles that provided sufficient data. We registered our review in the prospective registry of systematic reviews PROSPERO (Nr. 293,693). We identified 4,835 potentially relevant studies. We excluded 4,610 studies after abstract screening. We evaluated the full text of the remaining 225 studies, excluding 154. Ultimately, we included 71 articles with 978 cases of frostbite originating from 1 randomized controlled trial, 20 cohort studies and 51 case reports. We found wide variations in classifications of treatments and outcomes. The two meta-analyses we performed both found that patients treated with thrombolytics within 24 h had better outcomes than patients treated with other modalities. The one randomized controlled trial found that the prostacyclin analog iloprost was beneficial in severe frostbite if administered within 48 h. Conclusions Iloprost and thrombolysis may be beneficial for treating frostbite. The effectiveness of other commonly used treatments has not been validated. More prospective data from clinical trials or an international registry may help to inform optimal treatment.

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Successful Delayed Hyperbaric Oxygen Therapy and Iloprost Treatment on Severe Frostbite at High Altitude

Cited by 2 publications

References 10 publications

Iloprost for the treatment of frostbite: a scoping review

Iloprost for the treatment of frostbite: a scoping review

Frostbite treatment: a systematic review with meta-analyses

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