Analysis of Treatment Outcomes in Patients with Cold Injuries

Background: The aim of this research was to study the prevalence rate, structure, treatment methods and outcomes for patients with severe frostbite and hypothermia admitted to the Intensive Care Unit (ICU) for patients with thermal injuries.
Methods and Results: We performed a retrospective analysis of the treatment outcomes for 108 patients (83/76.9% men and 25/23.1% women) exposed to excessive natural cold  and treated in ICU-1 of Republican Hospital #2 - Center for Emergency Medical Aid in the city of Yakutsk in the period 2017-2019. The age of the adult patients ranged from 18 to 77 years (mean age of 47.5±14.9 years), and three children were 2, 4, and 17 years of age. The diagnosis of hypothermia was made by measuring the core (rectal) temperature (trect). The following gradation scale was applied: mild (trec 32°C-35°C), moderate (trec 28°C-32°C), and severe (trect <28°C) hypothermia.
The comprehensive treatment of frostbite was carried out in accordance with modern clinical guidelines. Among all patients with cold injuries, 38(35.2%) patients with combined hypothermia constituted the most severe category: mild hypothermia was observed in 26(68.4%), moderate in 7(18.4%), and severe in 5(13.2%) patients. Due to the development of tissue necrosis and its non-viability, various surgeries were performed on 33(30.5%) patients with third- and fourth-degree frostbite, including amputations of various limb segments in 29(87.9%) patients. The treatment duration for all the ICU patients with cold injury was 4.2±2.1 bed/days, and for the patients with combined hypothermia – 7.9±4.4 bed/days. Over the study period, 3(2.7%) patients with cold injury died.
Conclusion: The presented data show the relevance of the cold injury issue in the region, with severe frostbite with tissue necrosis resulting in amputation of extremities at different levels in 30.5% of the patients. Moreover, in 35.2% of the cases, frostbite was combined with hypothermia, which made the treatment even more difficult.