ABA GUIDELINESAmerican Burn Association Clinical Practice Guidelines onthe Treatment of Severe FrostbiteLucy Wibbenmeyer,MD,FACS',Alexandra M.Lacey,MD,RD,FACSt.,Frederick W.Endorf,MDt.Sarvesh Logsetty,MD,FRCS,FACS,Anne L.L.Wagner,MD,FACSs,,Angela L.F.Gibson,MD,PhD1,and Rachel M.Nygaard,PhDt.ABSTRACTThis Clinical Practice Guideline addresses severe frostbite treatment.We defined severe frostbite as atmosphericcooling that results in a perfusion deficit to the extremities.We limited our review to adults and excluded coldcontact or rapid freeze injuries that resulted in isolated devitalized tissue.After developing population,intervention,comparator,outcomes(PICO)questions,a comprehensive literature search was conducted with the help of aprofessional medical librarian.Available literature was reviewed and systematically evaluated.Recommendationsbased on the available scientific evidence were formulated through consensus of a multidisciplinary committee.We conditionally recommend the use of rapid rewarming in a 38 to 42C water bath and the use of thrombolyticsfor fewer amputations and or a more distal level of amputation.We conditionally recommend the use of"early"administration of thrombolytics(512 hours from rewarming)compared to "later"administrationof thrombolytics for fewer amputations and/or a more distal level of amputation.No recommendationcould be formed on the use of vascular imaging studies to determine the use of and/or the time to initiatethrombolytic therapy.No recommendation could be formed on the use of intravenous thrombolytics comparedto the use of intra-arterial thrombolytics on fewer amputations and /or a more distal level of amputation.Norecommendation could be formed on the use of iloprost resulting in fewer amputations and/or more distallevels of amputation.No recommendation could be formed on the use of diagnostic imaging modalities forsurgical planning on fewer amputations,a more distal level of amputation,or earlier timing of amputation.In conjunction with the American Burn Association (ABA)PURPOSEClinical Practice Guideline (CPG)ad hoc Committee,a mul-tidisciplinary ABA team including clinicians with experience inThe purpose of this CPG is to make recommendations,basedfrostbite management and frostbite researchers was selected toon the available scientific literature,on the treatment of severedevelop CPGs for the treatment of severe frostbite in adultsfrostbite.Early medical advances in frostbite treatment include(218 years of age)defined as atmospheric cooling resulting inrapid rewarming,oral ibuprofen,topical aloe vera,pressure re-a perfusion deficit to the extremities (hence referred to as se-lief,and wound care.1-Amajor advancement in the science ofvere frostbite).This committee includes all the listed authorsfrostbite treatment occurred with the use of thrombolytics tofor this CPG.reduce the injury caused by reperfusion following rewarming.Most research on the treatment and management of frostbiteinjury are limited to s
