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

• Published in: International Journal of Circumpolar Health
• Main Authors: Jonathon Lowe, Matthew Warner
• Format: Article in Journal/Newspaper
• Language: English
• Published: Taylor & Francis Group 2023
• Subjects: Frostbite; iloprost; NFCI; military; cold injury; Arctic medicine. Tropical medicine; RC955-962; Arctic; Circumpolar Health; International Journal of Circumpolar Health
• Online Access: https://doi.org/10.1080/22423982.2023.2210340; https://doaj.org/article/120f36c660c64705808c6e6212499ef2

ABSTRACTIntroduction: Cold Weather Injury (CWI) represents a spectrum of pathology, the two main divisions being Freezing Cold Injury (FCI) and Non-Freezing Cold Injury (NFCI). Both are disabling conditions associated with microvascular and nerve injury often treated hours after initial insult when presenting to a healthcarestablishment. Given that iloprost is used for the treatment of FCI, could it be used in a forward operating environment to mitigate treatment delay? Is there a role for its use in the forward treatment of NFCI? This review sought to evaluate the strength of evidence for the potential use of iloprost in a forward operating environment.Methods: Literature searches were undertaken using the following question for both FCI and NFCI: in [patients with FCI/NFCI] does [the use of iloprost] compared to [standard care] reduce the incidence of [long-term complications]. Medline, CINAHL and EMBASE databases were searched using the above question and relevant alternative terminology. Abstracts were reviewed before full articles were requested.Results: The FCI search yielded 17 articles that were found to refer to the use of iloprost and FCI. Of the 17, one referred to pre-hospital treatment of frostbite at K2 base camp; however, this was utilising tPA. No articles referred to pre-hospital use in either FCI or NFCI.Discussion: Although evidence exists to support the use of iloprost in the treatment of FCI, its use to date has been in hospital. A common theme is delayed treatment due to the challenges of evacuating casualties from a remote location. There may be a role for iloprost in the treatment of FCI; however, further study is required to better understand the risk of its use.