Pathophysiology of Crush Syndrome and Its Prehospital Management, with Preventive Strategies for Earthquake Victims

A Literature Review

Abstract

Earthquakes are major public health disasters that frequently cause building collapses and prolonged entrapment, resulting in crush injuries that may progress to crush syndrome (CS), a life-threatening systemic complication of traumatic muscle damage. This literature review aims to summarize the pathophysiology of CS and evaluate current prehospital management and preventive strategies to improve survival among earthquake victims. A comprehensive search of PubMed, ScienceDirect, and ResearchGate was conducted using the PICO framework and Boolean operators. Open-access English articles published between 2017 and 2026 were screened, yielding 17 eligible studies from 2,530 initial records for qualitative synthesis. The findings indicate that CS develops through ischemia during compression followed by reperfusion injury after extrication, leading to rhabdomyolysis, hyperkalemia, and acute kidney injury. Effective prehospital management includes rapid triage and early administration of potassium-free isotonic saline before extrication to reduce systemic complications. Adjunctive measures, including urine alkalinization with sodium bicarbonate, calcium gluconate for myocardial stabilization, and cooling therapy, may further improve outcomes. Early recognition and aggressive pre-extrication fluid resuscitation remain the cornerstone of CS management, minimizing reperfusion-related complications, preventing acute kidney injury, and improving survival in earthquake mass-casualty settings.