EARTHQUAKE KNOWLEDGE UPDATE

EARTHQUAKE KNOWLEDGE UPDATEkapak

CRUSH SYNDROME

Ayşe Balat1 Mehmet Şükrü Sever2

1Gaziantep University Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
2İstanbul University, Faculty of Medicine, Department of Nephrology, İstanbul, Türkiye

Balat A, Sever MŞ. Crush Syndrome. In: Kalenderer Ö, Servet E, editors. Earthquake Knowledge Update. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.45-55.

ABSTRACT

Traumatic rhabdomyolysis is frequent after destructive disasters in the victims who are entrapped under the rubble and may be complicated by crush syndrome (CS). Given the complexity of this problem, critical care should start even before the extraction of the victims. These interventions should include maintenance of airway patency, stabilization of the spine, control of traumatic bleeding by whatever means are available, and fluid resuscitation. Fluids may be useful not only for preventing crush-related acute kidney injury (AKI) but also to avoid many other complications, particularly life-threatening hyperkalemia. Other complications associated with CS include hypotension, shock, cardiac arrhythmias, and adult respiratory distress syndrome. The principles of treatment of CS-related AKI include maintenance of fluid-electrolyte and acid-base balance, initiating dialysis as needed, and prevention and management of complications.

It is essential to evaluate children independently from adults in disasters, as they possess distinct physiological characteristics and differing muscle mass. These differences mean their emergency needs and responses require specialized attention and, most importantly, tailored strategies. Understanding these unique traits is crucial for ensuring appropriate measures are taken to protect and support them during such critical situations.

In this study, CS, an important problem in earthquakes, will be discussed.

Keywords: Disaster; Earthquake; Crush syndrome; Acute kidney injury; Crush injury

Referanslar

  1. ReliefWeb. Glossary of Humanitarian Terms. [cited 2023 14 February]; Available from:  [Link]
  2. Sever MS, Vanholder R, and RDRTF of the ISN Work Group on Recommendations for the Management of Crush Victims in Mass Disasters, Recommendation for the management of crush victims in mass disasters. Nephrol Dial Transplant. 2012;27(1):i1-67. [Crossref]  [PubMed]
  3. Geetha D, Kronbichler A, Rutter M, Bajpai D, Menez S, Weissenbacher A, et al. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions. Nat Rev Nephrol. 2022;18(11):724-737. [Crossref]  [PubMed]  [PMC]
  4. Sever MS, Vanholder R, Luyckx V, Eckardt KU, Kolesnyk M, Wiecek A, et al. Armed conflicts and kidney patients: a consensus statement from the Renal Disaster Relief Task Force of the ERA. Nephrol Dial Transplant. 2023;38(1):56-65. [Crossref]  [PubMed]
  5. Karalar B. AFAD Başkanı Sezer: Depremde can kaybı 50 bin 96, yaralanan sayısı ise 107 bin 204. 2023 [cited 2023 25 July]; Available from:  [Link]
  6. Ozturk I, Gungor O, Ozturk S, Olmaz R, Keskin AJG, Kocyigit I, et al. Epidemiological analysis of the victims with crush syndrome in earthquakes of southeastern Turkey. J Nephrol. 2024;37(9):2589-2599. [Crossref]  [PubMed]
  7. Sheng ZY. Medical support in the Tangshan earthquake: a review of the management of mass casualties and certain major injuries. J Trauma. 1987;27(10):1130-5. [Crossref]  [PubMed]
  8. Villazon-Sahagun A. Mexico City Earthquake: Medical Response. J World Emerg Dis Med. 1986;(1-4):15-20. [Crossref]  [PubMed]
  9. Redmond AD. Response of the south Manchester accident rescue team to the earthquake in Armenia and the Lockerbie air disaster. BMJ. 1989;299:611-612. [Crossref]  [PubMed]  [PMC]
  10. Kantarci G, Vanholder R, Tuglular S, Akin H, Koç M, Ozener C, et al. Acute renal failure due to crush syndrome during Marmara earthquake. Am J Kidney Dis. 2002;40:682-689. [Crossref]  [PubMed]
  11. Jacquet GA, Hansoti B, Vu A, Bayram JD. Earthquake-related injuries in the pediatric population: a systematic review. PLoS Curr. 2013;5  [Link]
  12. Better OS, Abassi Z, Rubinstein I, Marom S, Winaver Y, Silberman M. The mechanism of muscle injury in the crush syndrome: ischemic versus pressure-stretch myopathy. Miner Electrolyte Metab. 1990;16(4):181-4.
  13. Better OS, Stein JH. Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med. 1990;322(12):825-9. [Crossref]  [PubMed]
  14. Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol. 2000;11(8):1553-1561. [Crossref]  [PubMed]
  15. Zager RA. Rhabdomyolysis and myohemoglobinuric acute renal failure. Kidney Int. 1996;49(2):314-26. [Crossref]  [PubMed]
  16. Sever MS. Rhabdomyolysis. Acta Clin Belg. 2007;62 Suppl 2:375-9. [Crossref]  [PubMed]
  17. Sever MS, Katı YA, Özkaya U. Destructive disasters, trauma, crush syndrome, and beyond. Acta Orthop Traumatol Turc. 2023;57(6):305-314. [Crossref]  [PubMed]  [PMC]
  18. Better OS. Rescue and salvage of casualties suffering from the crush syndrome after mass disasters. Mil Med. 1999;164(5):366-9. [Crossref]
  19. Sever MS, Vanholder R, Lameire N. Management of crush-related injuries after disasters. N Engl J Med. 2006;354(10):1052-63. [Crossref]  [PubMed]
  20. Sever MS, Erek E, Vanholder R, Akoglu E, Yavuz M, Ergin H, et al. Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake. Nephrol Dial Transplant. 2002;17(11):1942-9. [Crossref]  [PubMed]
  21. Kazancioglu R, Cagatay A, Calangu S, Korular D, Turkmen A, Aysuna N, et al. The characteristics of infections in crush syndrome. Clin Microbiol Infect. 2002;8(4):202-6. [Crossref]  [PubMed]
  22. Keven K, Ates K, Sever MS, Yenicesu M, Canbakan B, Arinsoy T, et al. Infectious complications after mass disasters: the Marmara earthquake experience. Scand J Infect Dis. 2003;35(2):110-3. [Crossref]  [PubMed]
  23. Sever MS, Lameire N, Van Biesen W, Vanholder R. Disaster nephrology: a new concept for an old problem. Clin Kidney J. 2015;8(3):300-9. [Crossref]  [PubMed]  [PMC]
  24. Vanholder R, Borniche D, Claus S, Correa-Rotter R, Crestani R, Ferir MC, et al. When the earth trembles in the Americas: the experience of Haiti and Chile 2010. Nephron Clin Pract. 2011;117(3):c184-97. [Crossref]  [PubMed]
  25. Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore). 1982;61(3):141-52. [Crossref]  [PubMed]
  26. Sever MS, Erek E, Vanholder R, Ozener C, Yavuz M, Ergin H, et al. Marmara Earthquake Study Group. The Marmara earthquake: admission laboratory features of patients with nephrological problems. Nephrol Dial Transplant. 2002;17(6):1025-31. [Crossref]  [PubMed]
  27. Sever MS, Erek E, Vanholder R, Kantarci G, Yavuz M, Turkmen A, et al. Marmara Earthquake Study Group. Serum potassium in the crush syndrome victims of the Marmara disaster. Clin Nephrol. 2003;59(5):326-33. [Crossref]  [PubMed]
  28. Oda J, Tanaka H, Yoshioka T, Iwai A, Yamamura H, Ishikawa K, et al. Analysis of 372 patients with Crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997;42(3):470-5; discussion 475-6. [Crossref]  [PubMed]
  29. Sever MS, Erek E, Vanholder R, Koc M, Yavuz M, Ergin H, et al. Marmara Earthquake Study Group. Treatment modalities and outcome of the renal victims of the Marmara earthquake. Nephron. 2002;92(1):64-71. [Crossref]  [PubMed]
  30. Sever MS, Erek E, Vanholder R, Akoğlu E, Yavuz M, Ergin H, et al; Marmara Earthquake Study Group. The Marmara earthquake: epidemiological analysis of the victims with nephrological problems. Kidney Int. 2001;60(3):1114-23. [Crossref]  [PubMed]
  31. Hwang SJ, Shu KH, Lain JD, Yang WC. Renal replacement therapy at the time of the Taiwan Chi-Chi earthquake. Nephrol Dial Transplant. 2001;16 Suppl 5:78-82. [Crossref]  [PubMed]
  32. McGee S, Abernethy WB 3rd, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA. 1999;281(11):1022-9. [Crossref]
  33. Sever MS, Vanholder R. Management of crush victims in mass disasters: highlights from recently published recommendations. Clin J Am Soc Nephrol. 2013;8(2):328-35. [Crossref]  [PubMed]
  34. Sever MS, Sever L, Vanholder R. Disasters, children and the kidneys. Pediatr Nephrol. 2020;35(8):1381-1393. [Crossref]  [PubMed]
  35. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2012;(6):CD000567. [Crossref]  [PubMed]
  36. Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med. 1999;27(1):200-10. [Crossref]  [PubMed]
  37. Slater MS, Mullins RJ. Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients: a review. J Am Coll Surg. 1998;186(6):693-716. [Crossref]  [PubMed]
  38. Hu Z, Zeng X, Fu P, Luo Z, Tu Y, Liang J, et al. Predictive factors for acute renal failure in crush injuries in the Sichuan earthquake. Injury. 2012;43(5):613-8. [Crossref]  [PubMed]
  39. Ito J, Fukagawa M. Predicting the risk of acute kidney injury in earthquake victims. Nat Clin Pract Nephrol. 2009;5(2):64-5. [Crossref]  [PubMed]
  40. Vanholder R, Sever MS, De Smet M, Erek E, Lameire N. Intervention of the Renal Disaster Relief Task Force in the 1999 Marmara, Turkey earthquake. Kidney Int. 2001;59(2):783-91. [Crossref]  [PubMed]
  41. Sever MS, Ortiz A, Maggiore U, Bac-García E, Vanholder R. Mass Disasters and Burnout in Nephrology Personnel: From Earthquakes and Hurricanes to COVID-19 Pandemic. Clin J Am Soc Nephrol. 2021;16(5):829-837. [Crossref]  [PubMed]
  42. Bakkaloğlu SA, Delibaş A, Sürmeli Döven S, Taner S, Yavuz S, Erfidan G, et al. Pediatric kidney care experience after the 2023 Türkiye earthquake. Nephrol Dial Transplant. 2024;39(9):1514-1522.
  43. Atmis B, Bayazit AK, Cagli Piskin C, Saribas E, Piskin FC, Bilen S, et al. Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week following rescue. Eur J Pediatr. 2023;182(12):5591-5598. [Crossref]
  44. Najafi I, Van Biesen W, Sharifi A, Hoseini M, Rashid Farokhi F, Sanadgol H, et al. Early detection of patients at high risk for acute kidney injury during disasters: development of a scoring system based on the Bam earthquake experience. J Nephrol. 2008;21(5):776-82. [Crossref]  [PubMed]
  45. Karakaya D, Yılmaz AÇ, Güngör T, Kenan BU, Çelikkaya E, Çakıcı EK. Is the renal score predictive for kidney replacement therapy in pediatric patients with crush syndrome? Pediatr Nephrol. 2024;39(1):291-296. [Crossref]  [PubMed]
  46. Turkish Society of Pediatric Nephrology. Guideline for Crush syndrome in children. [Crossref]  [PubMed]
  47. Abu-Zidan FM, Jawas A, Idris K, Cevik AA. Surgical and critical care management of earthquake musculoskeletal injuries and crush syndrome: A collective review. Turk J Emerg Med. 2024;24(2):67-79. [Crossref]  [PubMed]  [PMC]
  48. Vanholder R, Canaud B, Fluck R, Jadoul M, Labriola L, Marti-Monros A, et al. Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP). NDT Plus. 2010;3(3):234-246. [Crossref]  [PubMed]  [PMC]
  49. Yoshida T, Tada K, Uemura K, Yonenobu K. Peripheral nerve palsies in victims of the Hanshin-Awaji earthquake. Clin Orthop Relat Res. 1999;(362):208-17. [Crossref]  [PubMed]
  50. Sever MS, Erek E, Vanholder R, Koc M, Yavuz M, Aysuna N, et al. Lessons learned from the catastrophic Marmara earthquake: factors influencing the final outcome of renal victims. Clin Nephrol. 2004;61(6):413-21. [Crossref]  [PubMed]
  51. Bennett WM, Henrich WL, Stoff JS. The renal effects of nonsteroidal anti-inflammatory drugs: summary and recommendations. Am J Kidney Dis. 1996;28(1 Suppl 1):S56-62. [Crossref]  [PubMed]