Crush syndrome: a review for prehospital providers and emergency clinicians

Abstract

Introduction Disasters and accidents have occurred with increasing frequency in recent years. Primary disasters have the potential to result in mass casualty events involving crush syndrome (CS) and other serious injuries. Prehospital providers and emergency clinicians stand on the front lines of these patients’ evaluation and treatment. However, the bulk of our current knowledge, derived from historical data, has remained unchanged for over ten years. In addition, no evidence-based treatment has been established to date. Objective This narrative review aims to provide a focused overview of, and update on, CS for both prehospital providers and emergency clinicians. Discussion CS is a severe systemic manifestation of trauma and ischemia involving soft tissue, principally skeletal muscle, due to prolonged crushing of tissues. Among earthquake survivors, the reported incidence of CS is 2–15%, and mortality is reported to be up to 48%. Patients with CS can develop cardiac failure, kidney dysfunction, shock, systemic inflammation, and sepsis. In addition, late presentations include life-threatening systemic effects such as hypovolemic shock, hyperkalemia, metabolic acidosis, and disseminated intravascular coagulation. Immediately beginning treatment is the single most important factor in reducing the mortality of disaster-situation CS. In order to reduce complications from CS, early, aggressive resuscitation is recommended in prehospital settings, ideally even before extrication. However, in large-scale natural disasters, it is difficult to diagnose CS, and to reach and start treatments such as continuous administration of massive amounts of fluid, diuresis, and hemodialysis, on time. This may lead to delayed diagnosis of, and high on-site mortality from, CS. To overcome these challenges, new diagnostic and therapeutic modalities in the CS animal model have recently been advanced. Conclusions Patient outcomes can be optimized by ensuring that prehospital providers and emergency clinicians maintain a comprehensive understanding of CS. The field is poised to undergo significant advances in coming years, given recent developments in what is considered possible both technologically and surgically; this only serves to further emphasize the importance of the field, and the need for ongoing research.

Multidisciplinary approach to a 93‐year‐old survivor with crush syndrome: A 124‐h rescue operation after the 2024 Noto Peninsula earthquake

“…Crush syndrome, a significant concern in earthquake disasters, is known to be one of the leading causes of mortality, even after successful rescues. 2 , 3 This was evident in the 2024 Noto Peninsula earthquake, where at least six fatalities were reported due to crush syndrome, underscoring the severity of the condition in post‐disaster medical challenges. Comparatively, the 2023 Kahramanmaras earthquake in Turkey also caused a considerable number of crush injuries, 7.7% of the total injuries, 4 highlighting the global prevalence of this issue in seismic events.…”