Iloprost for the treatment of frostbite: a scoping review

Abstract

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.

Prolonged critical avalanche burial for nearly 23 hours with severe hypothermia and severe frostbite with good recovery: A case report

“…Unlike the strong correlation between treatment delay and limb/digit loss using thrombolytics in severe frostbite with no bene t after 24 h, iloprost bene t was evident even in delayed treatment up to 5 days [27,29]. Due to these results and the low complication rate [24], iloprost seems to be an important pillar in frostbite treatment in hypothermic patients, especially when the time to reach normothermia and normalisation of coagulation is prolonged. For wound healing improvement [30] and its antiin ammatory effects, dexamethasone was administered.…”

Prolonged critical avalanche burial for nearly 23 h with severe hypothermia and severe frostbite with good recovery: a case report

“…Thrombolysis has a risk of bleeding [ 24 ], resulting in complications such as compartment syndrome, and requires changes in frostbite management in 8.4% of cases [ 25 ]. Especially in patients with concomitant traumatic injuries, hypothermia-induced coagulopathy with elevated bleeding risk should also be considered.…”

“…High-quality evidence for severe frostbite treatment is lacking. It is possible that the combination of iloprost and anticoagulation with LMWH augmented the digit salvage rate [ 24 ]. Cauchy et al described a lower risk of digit loss in the iloprost group than in the iloprost and alteplase groups [ 27 ].…”

“…Unlike the strong correlation between treatment delay and limb/digit loss using thrombolytics in severe frostbite with no benefit after 24 h, iloprost benefit was evident even in delayed treatment up to 5 days [ 27 , 29 ]. Due to these results and the low complication rate [ 24 ], iloprost seems to be an important pillar in frostbite treatment in hypothermic patients, especially when the time to reach normothermia and normalisation of coagulation is prolonged. For wound healing improvement [ 30 ] and its anti-inflammatory effects, dexamethasone was administered.…”

Human performance and medical treatment during cold weather operations – synthesis of a symposium

“…This builds on the work of Poole and others who have demonstrated the benefits of iloprost in the treatment of FCI. A scoping review by Gautier et al [ 38 ] included 20 studies with a total of 254 patients and 1000 digits with FCI. The results of their analysis indicate a much lower amputation rate of digits in patients that had been treated with iloprost compared to those that had not received iloprost during their treatment.…”