Magnan MA, Gayet-Ageron A, Louge P, Champly F, Joffre T, Lovis C, Pignel R, et al.
Medicina (Kaunas, Lithuania). Date of publication 2021 Nov 22;volume 57(11):.
1. Medicina (Kaunas). 2021 Nov 22;57(11):1284. doi: 10.3390/medicina57111284.
Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe
Frostbite Compared to Iloprost Alone.
Magnan MA(1), Gayet-Ageron A(2), Louge P(1), Champly F(3), Joffre T(4), Lovis
C(5), Pignel R(1).
Author information:
(1)Hyperbaric Medicine Unit, Department of Acute Medicine, University Hospitals
of Geneva, 1205 Geneva, Switzerland.
(2)CRC & Division of Clinical-Epidemiology, Department of Health and Community
Medicine, University of Geneva & University Hospitals of Geneva, 1205 Geneva,
Switzerland.
(3)Emergency Department of Mont-Blanc Hospitals, The Mont-Blanc Hospitals, 74700
Chamonix-Sallanches, France.
(4)Hyperbaric Center, Hospices Civils de Lyon, University Hospitals of Lyon-1,
69003 Lyon, France.
(5)Division of Medical Information Sciences, Geneva University Hospitals and
University of Geneva, 1205 Geneva, Switzerland.
Background and Objectives: Frostbite is a freezing injury that can lead to
amputation. Current treatments include tissue rewarming followed by thrombolytic
or vasodilators. Hyperbaric oxygen (HBO) therapy might decrease the rate of
amputation by increasing cellular oxygen availability to the damaged tissues.
The SOS-Frostbite study was implemented in a cross-border program among the
hyperbaric centers of Geneva, Lyon, and the Mont-Blanc hospitals. The objective
was to assess the efficacy of HBO + iloprost among patients with severe
frostbite. Materials and Methods: We conducted a multicenter prospective
single-arm study from 2013 to 2019. All patients received early HBO in addition
to standard care with iloprost. Outcomes were compared to a historical cohort in
which all patients received iloprost alone between 2000 and 2012. Inclusion
criteria were stage 3 or 4 frostbite and initiation of medical care <72 h from
frostbite injury. Outcomes were the number of preserved segments and the rate of
amputated segments. Results: Thirty patients from the historical cohort were
eligible and satisfied the inclusion criteria, and 28 patients were
prospectively included. The number of preserved segments per patient was
significantly higher in the prospective cohort (mean 13 ± SD, 10) compared to
the historical group (6 ± 5, p = 0.006); the odds ratio was significantly higher
by 45-fold (95%CI: 6-335, p < 0.001) in the prospective cohort compared to the
historical cohort after adjustment for age and delay between signs of freezing
and treatment start. Conclusions: This study demonstrates that the combination
of HBO and iloprost was associated with higher benefit in patients with severe
frostbite. The number of preserved segments was two-fold higher in the
prospective cohort compared to the historical group (mean of 13 preserved
segments vs. 6), and the reduction of amputation was greater in patients treated
by HBO + iloprost compared with the iloprost only.
DOI: 10.3390/medicina57111284
PMCID: PMC8620371
PMID: 34833502 [Indexed for MEDLINE]
Conflict of interest statement: The authors declare no conflict of interest. The
Interreg committee and the Swiss Confederation had no role in the design of the
study; in the collection, analyses, or interpretation of data; in the writing of
the manuscript, or in the decision to publish the results.
