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Published on February 22, 2019
A new treatment for severe frostbite is saving patients’ fingers and toes at Essentia Health-St. Mary’s Medical Center in Duluth. Doctors are using a clot-busting drug developed for strokes to restore blood flow to thawed limbs.
Since November, the hospital’s Emergency Department has treated 18 patients for frostbite, including 12 with severe frostbite, says Dr. Adam Riutta, the Emergency Medicine physician who leads the department. Six patients received the drug treatment and did not need amputations, he says.
Amputation is expected in 30 to 40 percent of patients who suffer third- or fourth-degree frostbite, says Dr. Mark Scott, a trauma surgeon and the hospital’s interim adult trauma program medical director. Research at Hennepin County Medical Center in Minneapolis found the clot-busting drug can reduce that number to only 10 percent.
“We want to minimize amputations and the disability from frostbite,” Dr. Scott says. “If you lose your fingers or thumb, that’s life-altering and disabling. If you lose toes, it’s harder to balance and you fall more easily. Losing ears and a nose is disfiguring. These are significant injuries that change people’s lives.”
Frostbite causes small vessels to form clots, which prevent blood from flowing even after skin and tissue are rewarmed, Dr. Riutta explains. Using the drug alteplase, also known as tPA, breaks up the clots.
Like the drug’s use with strokes, timing is important. Patients need to begin treatment within six hours after they are rewarmed for the greatest benefit, says Dr. Scott. Six patients with severe frostbite this winter arrived too late to receive the drug, which Dr. Scott says illustrates why transfer to St. Mary’s, the region’s only Level I Adult Trauma Center, can be critical. The treatment is only used for severe frostbite and requires the patient to be in an intensive care unit like the Miller-Dwan Burn Center at Essentia Health-Duluth. The local burn center has a partnership with the Burn Center at Hennepin County Medical Center, which developed the tPA protocol for frostbite.
At St. Mary’s, the Emergency Department begins treating frostbite by warming the affected areas with tepid water, Dr. Riutta explains. A bone scan helps determine blood flow and whether the clot-busting drug is needed. Wounds from frostbite and burns are very similar so that’s why it’s good to have the expertise and resources of the region’s only burn center just a block away, explains Dr. Riutta.
Dr. Riutta says fingers, toes, ears and noses are at greatest risk for frostbite because they get a limited supply of blood and the body draws blood away from its periphery when it gets cold. Frostbite, like many burns, can be prevented by recognizing the danger of cold weather and wearing proper attire – warm hat, gloves and boots.
“The danger isn’t just when it’s extremely cold because people stay inside,” Dr. Scott says, pointing to the recent polar vortex when temperatures and wind chills dropped into the minus 40-degree range. “It’s when it’s warmer and people go outside less prepared for the cold and stay outside longer.”