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Background and Objectives : Frostbite is a freezing injury that can lead to amputation. Current treatments include tissue rewarming followed by thrombolytic or vasodilators. Hyperbaric oxygen (HBO) therapy might decrease the rate of amputation by increasing cellular oxygen availability to the damaged tissues. The SOS-Frostbite study was implemented in a cross-border program among the hyperbaric centers of Geneva, Lyon, and the Mont-Blanc hospitals. The objective was to assess the efficacy of HBO + iloprost among patients with severe frostbite. Materials and Methods: We conducted a multicenter prospective single-arm study from 2013 to 2019. All patients received early HBO in addition to standard care with iloprost. Outcomes were compared to a historical cohort in which all patients received iloprost alone between 2000 and 2012. Inclusion criteria were stage 3 or 4 frostbite and initiation of medical care <72 h from frostbite injury. Outcomes were the number of preserved segments and the rate of amputated segments. Results : Thirty patients from the historical cohort were eligible and satisfied the inclusion criteria, and 28 patients were prospectively included. The number of preserved segments per patient was significantly higher in the prospective cohort (mean 13 ± SD, 10) compared to the historical group (6 ± 5, p = 0.006); the odds ratio was significantly higher by 45-fold (95%CI: 6-335, p < 0.001) in the prospective cohort compared to the historical cohort after adjustment for age and delay between signs of freezing and treatment start. Conclusions : This study demonstrates that the combination of HBO and iloprost was associated with higher benefit in patients with severe frostbite. The number of preserved segments was two-fold higher in the prospective cohort compared to the historical group (mean of 13 preserved segments vs. 6), and the reduction of amputation was greater in patients treated by HBO + iloprost compared with the iloprost only.

Background: In France, patients with acute coronary syndromes (ACS) are usually transferred from remote hospitals to percutaneous coronary intervention (PCI) centres in mobile intensive care units (MICUs) with on-board medical staff. They are then returned to the remote hospitals by MICU 48 h after PCI. However, MICU transportation and beds in a PCI centre are in short supply. Therefore, we investigated clinical outcomes among intermediate-risk ACS patients who were transferred in private ambulances without an on-board medic or paramedic; and returned to the remote hospital sooner after PCI., Methods: In the French Alps, the RESURCOR network manages 'SCA-Alp' transfers using strict management protocols in ambulances with trained drivers and automatic external defibrillators, but without heart rhythm monitoring. We conducted an observational retrospective study that assessed outcomes (death and emergency return to the PCI centre within 48 h) in patients transferred using SCA-Alp. Our population comprised stabilized patients with ST-segment elevation myocardial infarction (STEMI) who returned to the remote hospital within 24-48 h of PCI, and uncomplicated patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24-72 h of symptom onset who come from and returned to ('round-trip') the remote hospital on the day of PCI (return < 12 h after PCI)., Results: Between 2010 and 2014, 101 STEMI and 490 NSTEMI patients were transferred using SCA-Alp. No adverse events occurred during transportation and no deaths were reported. Two of 591 patients (0.3% [95% confidence interval 0.1-1.4%]) experienced a stent thrombosis within 48 h of PCI that required a second urgent PCI; both were event free at 6-month follow-up., Conclusions: Inter-hospital transfer using SCA-Alp is associated with low event rates in intermediate-risk ACS patients, allowing a more streamlined use of medical facilities and freeing-up of beds in PCI centres.