Cooling for Thermal Burns: Clinical Effectiveness and Guidelines

Key Message

No evidence specific to the clinical effectiveness of cooling on burns affecting greater than 10% total body surface area was found. Based on evidence from one non-randomized study that included participants with burns with a total body surface area ranging from five to greater than 25%, the benefit of water first aid was greater in burns with smaller affected total body surface area, especially, medium total body surface area for admission to the intensive care unit. After water first aid, burns with larger total body surface area resulted in a longer hospital length of stay. In-hospital mortality was significantly and linearly associated with total body surface area. The benefit of cooling was greater in burns with smaller total body surface area for graft surgery. Recommendations regarding cooling acute thermal burns included: stopping the burning process by cooling any major burn or burn exceeding 10% total body surface area for at least twenty minutes; reducing risk of hypothermia by performing first aid, emergency management, and treatment in a warm environment, as well as reducing heat loss by keeping patients covered while exposing burned skin sequentially; and that ice or ice water should not be used due to the risk of hypothermia and impaired perfusion. The included evidence-based guideline further stated that burns affecting greater or equal to 15% total body surface area increase the risk of systemic morbidity and mortality and that burns damage the skin and increase the risk of hypothermia, especially in children. Overall, the evidence addressing the clinical effectiveness of cooling first aid to treat burns affecting greater than 10% total body surface area is sparse, particularly in children, where the surface area to body volume ratio is greater. Further high quality studies are needed to determine the optimal temperature, duration, and timing of cooling burns as well as the clinical effectiveness of cooling when burns affect greater than 10% of the total body surface area. Additionally, the effect of hypothermia on the relationship between burns and cooling needs to be addressed.