Can iloprost be used for treatment of cold weather injury at the point of wounding in a forward operating environment? A literature review

Figures & data

Table 1. Classification of Frostbite (Cauchy et al.) [8].

Grade of Frostbite	Appearance after Rewarming	Amputation Risk
Grade 1	Absence of cyanosis	No amputation of bone
Grade 2	Cyanosis on distal phalanx	Moderate risk of amputation
Grade 3	Cyanosis up to middle phalanx joint	High risk of amputation
Grade 4	Cyanosis proximal to middle phalanx joint	Risk of amputation 100%

Table 2. Treatment protocol for hospital use of iloprost (Cauchy et al.) [8].

Administration and Monitoring	Dilute 1 vial 0.5 mL iloprost in 24.5 mL NaCl 9% Syringe pump: 25 mL – speed: 1 mL/h for 30 min, then 2 mL/h for 30 min, then 3 mL/h for 30 min, then 4 mL/h for weight<75 kg or 5 mL/h for weight>75 kg Continue until 25 mL is delivered; all patients receive 1 vial Monitor HR and BP every 30 min
Complications and their Management	In case of side effects decrease to previous step If systolic BP <90 mmHg, decrease to lower step
Contraindications	Hypotension, hypersensitivity, pulmonary oedema, cardiac arrhythmia, active ulcer disease, major trauma; unknown effects on pregnancy
Precautions	Anticipate nausea and vomiting, pain and hypotension, keep patient supine

Figure 1. Methodology Flow Diagram (Fci).

Figure 2. Methodology flow diagram (Nfci).

Cauchy E, Davis C, Paquier M, et al. A New Proposal for Management of Severe Frostbite in the Austere Environment. Wildern Environ Med. 2016 03;27(1):92–99.

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