Wibbenmeyer L, Lacey AM, Endorf FW, Logsetty S, Wagner ALL, Gibson ALF, Nygaard RM, et al.
Journal of burn care & research : official publication of the American Burn Association. Date of publication 2023 Apr 13;volume ():.
1. J Burn Care Res. 2023 Apr 13:irad022. doi: 10.1093/jbcr/irad022. Online ahead
of print.
American Burn Association Clinical Practice Guidelines on the Treatment of
Severe Frostbite.
Wibbenmeyer L(1), Lacey AM(2), Endorf FW(3), Logsetty S(4), Wagner ALL(5),
Gibson ALF(6), Nygaard RM(3).
Author information:
(1)Department of Surgery, University of Iowa, Iowa City, IA 52242, USA.
(2)Department of Surgery, Regions Hospital, Saint Paul, MN 55101, USA.
(3)Department of Surgery, Hennepin Healthcare, Minneapolis, MN 55415, USA.
(4)Departments of Surgery, Psychiatry, and Children's Health, University of
Manitoba, Winnipeg, Manitoba R3E 3P5, Canada.
(5)Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
37212, USA.
(6)Department of Surgery, University of Wisconsin School of Medicine and Public
Health, Madison, WI 53792, USA.
This Clinical Practice Guideline addresses severe frostbite treatment. We
defined severe frostbite as atmospheric cooling that results in a perfusion
deficit to the extremities. We limited our review to adults and excluded cold
contact or rapid freeze injuries that resulted in isolated devitalized tissue.
After developing population, intervention, comparator, outcomes (PICO)
questions, a comprehensive literature search was conducted with the help of a
professional medical librarian. Available literature was reviewed and
systematically evaluated. Recommendations based on the available scientific
evidence were formulated through consensus of a multidisciplinary committee. We
conditionally recommend the use of rapid rewarming in a 38 to 42°C water bath
and the use of thrombolytics for fewer amputations and/or a more distal level of
amputation. We conditionally recommend the use of "early" administration of
thrombolytics (≤12 hours from rewarming) compared to "later" administration of
thrombolytics for fewer amputations and/or a more distal level of amputation. No
recommendation could be formed on the use of vascular imaging studies to
determine the use of and/or the time to initiate thrombolytic therapy. No
recommendation could be formed on the use of intravenous thrombolytics compared
to the use of intra-arterial thrombolytics on fewer amputations and/or a more
distal level of amputation. No recommendation could be formed on the use of
iloprost resulting in fewer amputations and/or more distal levels of amputation.
No recommendation could be formed on the use of diagnostic imaging modalities
for surgical planning on fewer amputations, a more distal level of amputation,
or earlier timing of amputation.
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DOI: 10.1093/jbcr/irad022
PMID: 37045447
