Effectiveness of intravenous prostaglandin to reduce digital amputations from frostbite: an observational study,Canadian Journal of Emergency Medicine

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Effectiveness of intravenous prostaglandin to reduce digital amputations from frostbite: an observational study
Canadian Journal of Emergency Medicine ( IF 2.0 ) Pub Date : 2022-07-23 , DOI: 10.1007/s43678-022-00342-9
Sean Crooks _{1,

2} , Brett H Shaw _{1,

2} , James E Andruchow _{1,

2} , Chel Hee Lee ₃ , Ian Walker _{1,

2}

Affiliation

Purpose

We assessed the effectiveness and safety of a 5-day intravenous prostaglandin (iloprost) protocol at reducing digital amputation for patients with severe frostbite injuries at urban emergency departments.

Methods

This retrospective study examines consecutive patients who presented to Calgary emergency departments from April 2017 to April 2020 with Grade 2–4 frostbite injuries. Patients from February 2019 onward were managed using a 5-day iloprost infusion protocol, whereas patients prior to this time were managed with standard care (local best practice without iloprost as a therapeutic option). The primary effectiveness outcome was rate of affected digits amputated, stratified by frostbite severity. The secondary safety outcome was the incidence of serious adverse events associated with iloprost (allergic reactions or symptomatic hypotension requiring treatment or discontinuation of the infusion).

Results

90 patients were included, 26 were treated with iloprost, compared to 64 patients who received usual care. Both the treatment and usual care groups experienced substantial rates of homelessness and substance use. No digital amputations were required for patients with Grade 2 injuries in either group, but significantly lower digital amputation rates were observed for patients with more severe frostbite injuries treated with iloprost versus usual care: Grade 3 (18% vs 44%, p < 0.001), Grade 4 (46% vs 95%, p < 0.001). No serious adverse events were associated with iloprost.

Conclusion

In this unselected socially complex urban population, administration of iloprost for patients with frostbite was shown to be safe and was associated with lower digital amputation rates, particularly for those with more severe injuries.

中文翻译：

静脉注射前列腺素对减少冻伤导致手指截肢的有效性：一项观察性研究

目的

我们评估了 5 天静脉注射前列腺素（伊洛前列素）方案在减少城市急诊科严重冻伤患者数字截肢方面的有效性和安全性。

方法

这项回顾性研究检查了 2017 年 4 月至 2020 年 4 月在卡尔加里急诊科就诊的 2-4 级冻伤损伤的连续患者。从 2019 年 2 月起，患者使用为期 5 天的伊洛前列素输注方案进行治疗，而在此之前的患者则接受标准护理（当地最佳实践，没有伊洛前列素作为治疗选择）。主要有效性结果是受影响的手指截肢率，按冻伤严重程度分层。次要安全性结局是与伊洛前列素相关的严重不良事件（需要治疗或停止输注的过敏反应或症状性低血压）的发生率。

结果

纳入了 90 名患者，其中 26 名接受了伊洛前列素治疗，而 64 名患者接受了常规治疗。治疗组和常规护理组都经历了大量的无家可归和物质使用率。两组中的 2 级损伤患者均不需要进行手指截肢，但观察到使用伊洛前列素治疗的严重冻伤患者的手指截肢率显着低于常规护理：3 级（18% 对 44%，p < 0.001） , 4 级 (46% 对 95%, p < 0.001)。没有严重的不良事件与伊洛前列素相关。