Interventions for frostbite injuries, finds Study
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Frostbite is a thermal injury caused when tissue is exposed to sub-zero temperatures long enough for ice crystals to form in the affected tissue. Depending on the degree of tissue damage: thrombosis, ischaemia, necrosis (tissue death), gangrene and ultimately amputation may occur. Several interventions for frostbite injuries have been proposed, such as hyperbaric oxygen therapy, sympathectomy (nerve block), thrombolytic (blood-thinning) therapy and vasodilating agents such as iloprost, reserpine, pentoxifylline and buflomedil.

A Study was conducted to assess the benefits and harms of the different management options for frostbite injuries. Researchers included randomised controlled trials (RCTs) that compared any medical intervention, e.g. pharmacological therapy, topical treatments or rewarming techniques, for frostbite injuries to another treatment, placebo or no treatment.

Researchers used Review Manager 5 for statistical analysis of dichotomous data with risk ratio (RR) with 95% confidence intervals (CIs) and the Cochrane 'Risk of bias' tool to assess bias in the included trial. Incidence of amputations, rates of serious and non-serious adverse events, acute pain, chronic pain, ability to perform activities of daily living, quality of life, withdrawal rate from medical therapy due to adverse events, occupational effects and mortality were assessed.

Results:
One, open-label randomised trial were included involving 47 participants with severe frostbite injuries. This trial was judged to be at high risk of bias for performance bias, and uncertain risk for attrition bias; all other risk of bias domains were judged as low.

All participants underwent rapid rewarming, received 250 mg of aspirin and 400 mg (IV) buflomedil (since withdrawn from practice), and were then randomised to one of three treatment groups for the following 8 days.
Group 1 received additional IV buflomedil 400 mg for one hour per day.
Group 2 received the prostacyclin, iloprost, 0.5 ng to 2 ng/kg/min IV for six hours per day.
Group 3 received IV iloprost 2 ng/kg/min for six hours per day plus fibrinolysis with 100 mg recombinant tissue plasminogen activator (rtPA) for the first day only.

--The results suggest that iloprost and iloprost plus rtPA may reduce the rate of amputations in people with severe frostbite compared to buflomedil alone, RR 0.05 and RR 0.31 respectively.
--Iloprost may be as effective as iloprost plus rtPA at reducing the amputation rate, RR 0.14.
--Adverse events (including flushing, nausea, palpitations and vomiting) were common, but not reported separately by comparator arm (very low-quality evidence).

There is a paucity of evidence regarding interventions for frostbite injuries. It is indicated that iloprost, and iloprost plus rtPA, in combination with buflomedil may reduce the need for amputation in people with severe frostbite compared to buflomedil alone.

Source: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012980.pub2/full
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