Decreasing the Zone of Stasis in Electrical Burns
Cooling burns with cold (15° to 25°C) tap water until pain is relieved is the most effective method to decrease the zone of stasis in electrical burns. 1
Understanding Burn Zones and Stasis
Electrical burns create three distinct zones of injury:
- Zone of coagulation (central necrotic area)
- Zone of stasis (surrounding area with compromised blood flow)
- Zone of hyperemia (outermost area with increased blood flow)
The zone of stasis is critical because it contains potentially salvageable tissue that may either recover or progress to necrosis depending on treatment.
Evidence-Based Management to Decrease Zone of Stasis
Immediate Cooling
- Apply cold (15° to 25°C) tap water to the burn area for 10-20 minutes 1
- This reduces tissue temperature and limits ongoing thermal damage
- Do NOT apply ice directly to burns as this can worsen tissue damage (Class III, LOE B) 1
Wound Care After Cooling
- Cover burns with sterile, non-adherent dressings 1
- Leave burn blisters intact as this improves healing and reduces pain 1
- Apply antibiotic ointment for superficial injuries if no allergies 1
Why Cooling Works to Decrease Zone of Stasis
Cooling the burn area:
- Reduces metabolic demands of injured tissue
- Decreases inflammatory response
- Limits edema formation
- Preserves microcirculation
- Prevents vasoconstriction that would otherwise occur in the zone of stasis
Common Pitfalls to Avoid
- Using ice directly on burns (causes vasoconstriction and can worsen tissue damage)
- Applying cold water for too long (>20 minutes can cause hypothermia)
- Delaying cooling (should be initiated as soon as possible after ensuring scene safety)
- Failing to remove jewelry or constrictive items before swelling occurs
- Applying home remedies (butter, oil, etc.) that trap heat and worsen damage
Additional Considerations
Recent research has explored pharmacological interventions for salvaging the zone of stasis:
- N-Acetylcysteine has shown promise in reducing tissue destruction in electrical burns 2
- Glutathione 3, pentoxifylline 4, and melatonin 5 have demonstrated effectiveness in experimental studies
- Subatmospheric pressure therapy may help preserve microcirculation 6
However, these interventions are still experimental and not yet incorporated into standard guidelines. The most established and guideline-recommended approach remains proper cooling with room temperature water.