Earthquakes frequently cause devastating structural collapses. These catastrophic events often result in traumatic rhabdomyolysis. Consequently, survivors may develop a life-threatening systemic condition known as crush syndrome (CS). Therefore, effective crush injury syndrome management remains a critical priority for emergency responders. Recently, researchers conducted a comprehensive meta-analysis to synthesize global data on this condition. Furthermore, they aimed to clarify the frequency of complications.

Notably, the systematic review included fifty studies published between 1988 and 2023. Overall, most data originated from high-risk regions like Turkey, Iran, and China. Specifically, the researchers observed substantial heterogeneity across the literature. However, this variation occurred largely due to inconsistent definitions of CS. Regardless, the findings highlight a massive clinical burden. In particular, the pooled proportion of patients requiring dialysis reached 0.49. Thus, nearly half of all affected victims develop severe renal failure.

Moreover, the overall pooled mortality rate stood at 0.08. Specifically, this figure varied significantly across different geographic regions. For instance, some areas reported mortality as low as 1%. In contrast, other regions reached 26%. Consequently, this variation likely reflects differences in rescue capabilities and medical infrastructure. Additionally, Acute Kidney Injury (AKI) emerged as the most frequent complication. Indeed, 49% of victims suffered from AKI. Similarly, clinicians consistently reported marked creatine kinase elevation and metabolic derangements.

Best Practices in Crush Injury Syndrome Management

Accordingly, standardized care is essential for improving survival rates. First, clinicians must prioritize early and aggressive volume resuscitation. Furthermore, medical teams should initiate isotonic saline even before extrication. Specifically, this intervention helps prevent the toxic effects of myoglobin and potassium. In addition, hospitals must ensure surge capacity for renal replacement therapy (RRT). Because so many patients require dialysis, having portable RRT units in disaster zones can save lives.

Conversely, surgeons must carefully evaluate the need for fasciotomies. Although these procedures can relieve pressure, they also increase the risk of infection and sepsis. Therefore, evidence-based protocols should guide surgical decisions. Finally, the study emphasizes the urgent need for a universal diagnostic definition of crush syndrome. Consequently, standardized criteria will allow for better data collection. Overall, this progress will lead to more effective triage in future disasters.

How soon should fluid resuscitation begin?

Fluid resuscitation should ideally start before extrication. Initiating isotonic saline while the victim is still trapped can mitigate the risk of sudden cardiac arrest and acute kidney injury once the compression is released.

What are the main laboratory markers for crush syndrome?

Clinicians should monitor creatine kinase (CK) levels and metabolic derangements. Marked CK elevation and hyperkalemia are classic indicators of muscle breakdown and systemic toxicity.

Why is there such variation in mortality rates?

Mortality varies due to differences in response time, the duration of entrapment, and the availability of specialized care like dialysis. Regions with better disaster preparedness and surge capacity generally report lower mortality.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Rostami P et al. Crush injury syndrome in earthquakes: a systematic review and meta-analysis on its frequency and complications. BMC Emerg Med. 2026 Apr 02. doi: 10.1186/s12873-026-01516-9. PMID: 41928063.

2. Sever MS, Vanholder R. Management of crush victims in mass disasters: highlights from recent experiences. CJASN. 2011;6(4):946-955.

3. Khan S, Neradi D, Unnava N, Jain M, Tripathy SK. Pathophysiology and management of crush syndrome: A narrative review. World J Orthop. 2025 Apr 18;16(4):104489.