Crush syndrome

Crush syndrome (also traumatic rhabdomyolysis or Bywaters' syndrome) is a serious medical condition characterized by major shock and renal failure following a crushing injury to skeletal muscle. Cases commonly occur in catastrophes such as earthquakes or war, where victims have been trapped under fallen masonry (the syndrome was discovered by British physician Eric Bywaters in patients during the 1941 London Blitz).

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It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of toxic chemicals - notably myoglobin, potassium and phosphorus - that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions).

The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.

In view of the risk of crush syndrome, current recommendation to lay first-aiders (in the UK) is not to release victims of crush injury who have been trapped for over 15 minutes.

References

• Bywaters EG, Beall D. Crush injuries with impairment of renal function. Br Med J 1941;1:427-32
• Sever MS et al. Management of Crush-Related Injuries after Disasters. NEJM 2006;354:1052-63