Remote Delivery of Thrombolytics Prior to Transfer to a Regional Burn Center for Tissue Salvage in Frostbite: A Single-center Experience of 199 Patients
Heather Carmichael, Samuel Michel, Tyler M Smith, Patrick Duffy, Arek J Wiktor, Anne L Lambert Wagner
Abstract
While much has been published on the efficacy and safety of systemic thrombolytics in the treatment of acute frostbite, there has been limited investigation into administration outside a tertiary care setting. Here, we present a single-center experience with remote initiation of intravenous tissue plasminogen activator (tPA) at referring hospitals prior to transfer to a regional burn center. A modified Hennepin Quantification Score based on tissue involvement was used to determine eligibility for tPA and to quantify the severity of amputation. This is a retrospective review of patients with acute frostbite of the digits admitted to a single verified burn center over a 5-yr period. Of 199 patient admissions, 40 received tPA remotely pre-transfer, 32 received tPA on admission to our institution, and 127 patients did not qualify for tPA therapy according to the protocol. Comparing patients who required any amputation (n = 99, 49.7%) to those who did not, patients who received remote tPA had lower odds of any amputation compared to both those receiving tPA at our institution (OR 0.19, 95% CI 0.05-0.65, P = 0.01) and the group receiving no tPA (OR 0.14, 95% CI 0.05-0.40, P < 0.001) after controlling for confounders. Only one patient receiving pre-transfer tPA according to the protocol (2.3%) had a significant bleeding event requiring transfusion. These results support the protocolized use of thrombolytic therapy for frostbite prior to transfer to a tertiary center.