CanadiEM - By Samuel Wilson - October 25, 2022
Ref: Crooks S, Shaw BH, Andruchow JE, Lee CH, Walker I. Effectiveness of intravenous prostaglandin to reduce digital amputations from frostbite: an observational study. Can J Emerg Med. Published online July 23, 2022:622-629. doi:10.1007/s43678-022-00342-9
When we are dealing with frostbite in the ED, traditionally, management is focused on re-warming (of both an extremity, or simply the entire patient!). Depending on severity and patient characteristics, the question is whether or not amputation is required to debride necrotic tissues (or digits…) that are too severe or late for rewarming. Studies in the past have looked at using prostaglandin to help prevent amputation, and have shown considerable benefit in healthy (we’re talking your mountaineers…) patients, though your typical ED patient had never been studied until now!
The authors of this paper compared the amputation rates of patients who were eligible and received IV prostaglandin, vs those who received a placebo. The results signal potential for massive benefit. This benefit is most substantial in the most severely affected patients, though remains throughout. Moving forward, consider reaching out to your admitting plastic surgery consultants when you see your next patient who may benefit.
