CRUSH SYNDROME SUSTAINED IN THE 1995 KOBE, JAPAN, EARTHQUAKE - TREATMENT AND OUTCOME

Study objective: To assess the treatment and outcome of patients with crush syndrome sustained in an earthquake disaster. Methods: We conduc ted a retrospective analysis of eight patients with crush syndrome and subsequent acute kidney failure who were treated in the ICU of a univ ersity hospital. All eight patients had been extricated from buildings that collapsed in the 1995 Kobe, Japan, earthquake. Crush injury invo lved the upper extremities in one patient and the lower extremities in seven. Each patient received intravenous fluid infusion and diuretic drugs and underwent hemodialysis. Emergency fasciotomy was performed i n same patients, 17 to 100 hours after extrication. Results: All patie nts were conscious and lucid on admission, and blood pressure and hear t rate were normal. All the patients demonstrated kidney failure with increased concentrations of serum creatinine (1.9 to 9.6 mg/dL [169 to 852 mu mol/L]). Six patients were oliguric. Hyperkalemia (5.6 to 8.8 mEq/L) was present in six patients. We found close correlations betwee n the serum potassium and creatine kinase concentrations, between the serum myoglobin and potassium concentrations, and between the serum my oglobin and creatine kinase concentrations. All the patients were wean ed from hemodialysis. The serum creatinine concentration decreased to a normal revel within 20 to 52 days of admission in air patients. No p atients underwent amputation. Muscle weakness and sensory deficits per sisted in ail patients 6 months after the earthquake. Conclusion: Our findings support current therapeutic strategies for crush syndrome, de spite the long delay to initiation of intensive therapy. All the patie nts recovered kidney function and were weaned from hemodialysis; none required amputation.