Huang Fuguo

Characteristics of crush syndrome caused by prolonged limb compression longer than 24 h in the Sichuan earthquake

Background To assess the characteristics, treatment and outcome of patients with crush syndrome caused by prolonged limb compression longer than 24 h in the Sichuan earthquake. Methods Following the Sichuan earthquake, 2728 patients were transferred to the West China Hospital of Sichuan University and 157 of those were admitted to the intensive care unit. The medical records of nine severe crush syndrome patients were retrospectively reviewed. Results The major associated injuries were in the lower extremities. Renal failure and oliguria developed in all patients. Creatine kinase peaked in all patients. Hyperkalaemia was seen in five patients, and six patients developed acidosis. All patients had amputations; five had two limbs amputated. One patient underwent fasciotomy. Adult respiratory distress syndrome developed in four patients and required mechanical ventilation. All patients underwent haemodialysis. Multiple organ failure and sepsis developed in eight patients, but no patients died. Conclusions Crush syndrome caused by extremely long compression has high rates of renal failure, multiple organ failure, sepsis and amputation. Early transportation and immediate intensive care therapy would have improved the outcome and survival rate.

Infectious complications in patients with crush syndrome following the Wenchuan earthquake

Objective: To analyze the results of clinical and bacteriological examinations in patients with crush syndrome who suffered infectious complications after an earthquake in Sichuan, China. Methods: A total of 313 bacteriological samples among 147 patients with crush syndrome were collected. Infectious complications, results of microbiological examinations, potential risk factors of infection and mortality were analyzed statistically. Results: In the obtained database, 112 out of the 147 (75.7%) patients had infectious complications, in which, wound infection, pulmonary infection, and sepsis were most common. The time under the rubble and the time from injury to treatment were related to the occurrence of wound infection (P=0.013, odds ratio 2.25; P=0.017, odds ratio 2.31). Sepsis and wound infection were more common in patients who underwent fasciotomy or amputation than in those who did not (P=0.001). Conclusion: Quick rescue and injury treatment can decrease the infection risk in crush syndrome patients. It is better to obtain microorganic proofs before applying antibiotics, and bacteriological and drug sensitivity data should be taken into account, especially considering that most of these infections are hospital‐acquired and drug resistance. Emphasizing the accuracy and efficiency of wound management in emergency situations, cautiously assessing the indications for fasciotomy to avoid open wounds from unnecessary osteofascial compartment decompression incisions may decrease the incidence of infection and ameliorate the prognosis.