The Role of Rapid Enzymatic Escharotomy and Eschar Removal in Burn Mass Casualty Incidents Academic Article uri icon


  • Study/Objective To present a rapid acting enzymatic debridement agent that can help overcome bottlenecks and increase surge capacity in the treatment of burn mass casualty incidents (BMCI). Background BMCI are quite common worldwide, and in developing countries have even been termed a silent epidemic. Agencies dealing with CBRN preparedness estimate that the detonation of a nuclear device in a major city will lead to thousands of conventional burn victims, in addition to other tragic results. Reducing dependency on scarce, highly trained surgical teams and surgical facilities is a major goal in preparedness for BMCI, as these are the main established bottlenecks. Methods NexoBrid (NXB) is an enzymatic debriding agent evaluated in numerous preclinical and clinical studies, proving its efficacy in removing burn eschar rapidly and selectively in a single 4 hour application. NXB can be applied immediately on fresh burns indiscriminately of burn depth as it does not harm viable tissue, leading to significantly reduced needs for surgical facilities and blood loss. The clean wound bed can then be covered by dressings allowing for spontaneous healing or autografted as needed. Results NXB has been proved to be a rapid effective debriding agent. Early NXB debridement significantly reduces the surgical burden (surgical debridement, autografting and escharotomy) and the dependency on specialized personnel and facilities. Its use in a real BMCI has already been demonstrated after the Romanian nightclub fire in 2015. Additionally, a porcine study has also demonstrated NXB ability to debride Sulfur Mustard contaminated tissues. Conclusion NXB significantly reduces surgical burden thus offering a potential solution for first line escharotomy and eschar removal in BMCI.

publication date

  • April 1, 2017