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. 2022 Oct 23;23(6):872-877.
doi: 10.5811/westjem.2022.8.55020.

Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department

Sarah M Raleigh  1 , Margot Samson  1 , Rachel Nygaard  2 , Fredrick Endorf  2 , Joseph Walter  3 , Thomas Masters  1   3
Affiliations

Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department

Sarah M Raleigh et al. West J Emerg Med. .

Abstract

Introduction: Frostbite leads to progressive ischemia eventually causing tissue necrosis if not quickly reversed. Patients with frostbite tend to present to the emergency department (ED) for assessment and treatment. Acute management includes rewarming, pain management, and (when indicated) thrombolytic therapy. Thrombolytic therapy in severe frostbite injury may decrease rates of amputation and improve patient outcomes. Fluorescence microangiography (FMA) has been used to distinguish between perfused and non-perfused tissue. The purpose of this study was to evaluate the potential role of FMA in the acute care of patients with frostbite, specifically its role as a tool to identify perfusion deficit following severe frostbite injury, and to explore its role in time to tissue plasminogen activator (tPA).

Methods: This retrospective analysis included all patients from December 2020-March 2021 who received FMA in a single ED as part of their initial frostbite evaluation. In total, 42 patients presented to the ED with concern for frostbite and were evaluated using FMA.

Results: Mean time from arrival in the ED to FMA was 46.3 minutes. Of the 42 patients, 14 had clinically significant perfusion deficits noted on FMA and received tPA. Mean time to tPA (measured from ED arrival to administration of tPA) for these patients was 117.4 minutes. This is significantly faster than average historical times at our institution of 240-300 minutes.

Conclusion: Bedside FMA provides objective information regarding perfusion deficits and allows for faster decision-making and improved times to tPA. Fluorescence microangiography shows promise for quick and efficient evaluation of perfusion deficits in frostbite-injured patients. This could lead to faster tPA administration and potentially greater rates of tissue salvage after severe frostbite injury.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Use of bedside fluorescence microangiography in the emergency department for evaluation of a patient with possible frostbite. Lack of fluorescence (dark colored tissue in photos) indicates no fluorescein perfusion.
Figure 2
Figure 2
Time to fluorescence microangiography and time to tissue plasminogen activator from arrival in the emergency department. tPA, tissue plasminogen activator; FM, fluorescence microangiography.
See this image and copyright information in PMC

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