From the Guidelines
Hyperbaric oxygen therapy (HBOT) is a beneficial adjunctive treatment for frostbite injury, as it delivers 100% oxygen at increased atmospheric pressure, enhancing oxygen delivery to damaged tissues and promoting wound healing. The treatment works through several mechanisms, including increasing oxygen concentration in plasma, reducing tissue edema, inhibiting neutrophil adhesion, and promoting angiogenesis 1. For frostbite specifically, HBOT counteracts tissue hypoxia caused by ice crystal formation in tissues and blood vessels, which damages cell membranes and causes microvascular thrombosis. Key aspects of HBOT for frostbite treatment include:
- Treatment is most effective when started within 24-48 hours of injury, though benefits may still occur with delayed treatment
- HBOT is typically used as an adjunct to standard frostbite care, which includes rapid rewarming, wound care, and sometimes thrombolytic therapy for severe cases
- Patients should be aware that multiple daily treatments may be required, and the therapy is contraindicated in certain conditions like untreated pneumothorax or recent ear surgery According to the most recent guidelines, the use of hyperbaric oxygen therapy as an adjunctive treatment is conditionally recommended, as it has been shown to improve wound healing in certain cases, although the evidence is limited and the certainty of evidence is low 1. In the context of frostbite treatment, it is essential to follow standard first aid procedures, including rapid rewarming and protection from refreezing, as outlined in the 2010 American Heart Association and American Red Cross guidelines for first aid 1. Overall, HBOT can be a valuable addition to standard frostbite care, but its use should be carefully considered on a case-by-case basis, taking into account the individual patient's condition and the availability of hyperbaric oxygen therapy facilities.
From the Research
Mechanism of Hyperbaric Oxygen Therapy in Frostbite Injury
- Hyperbaric oxygen therapy (HBOT) increases cellular oxygen availability to damaged tissues, potentially reducing the rate of amputation 2, 3.
- HBOT may improve the demarcation level of frostbite, leading to better outcomes 2.
- The combination of HBOT and iloprost, a vasodilator, has been shown to be effective in treating severe frostbite, with a higher number of preserved segments and reduced amputation rates compared to iloprost alone 3, 4.
Effects of Hyperbaric Oxygen Therapy on Frostbite Injury
- HBOT has been used as an adjunct to wound care in the treatment of frostbite, with positive outcomes reported in several studies 2, 3, 4.
- The use of HBOT in combination with other treatments, such as iloprost and anticoagulant therapy, may lead to improved outcomes, including reduced amputation rates and improved digit salvage 3, 4.
- HBOT may also reduce the risk of long-term sequelae, such as arthritis, in patients with frostbite injuries 4.
Limitations and Potential Side Effects of Hyperbaric Oxygen Therapy
- HBOT can cause side effects, including otologic barotrauma, nausea, vomiting, anxiety, oxygen toxicity seizure, and myopic changes 2.
- The effectiveness of HBOT in treating frostbite injuries may be limited by the timing of treatment, with earlier treatment generally leading to better outcomes 5, 4.
- Further research is needed to fully understand the benefits and limitations of HBOT in the treatment of frostbite injuries, as well as to establish firm evidence for its use in clinical practice 5.