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What is Crush Syndrome?

By D. Jeffress
Updated Mar 03, 2024
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Crush syndrome is a potentially life-threatening complication of a traumatic injury in which a body part is subjected to compressing force for a long period of time. Building collapses, natural disasters, severe car accidents, and other scenarios can leave a person trapped underneath heavy rubble. When a body part is crushed, muscles are deprived of oxygen and begin to die. Damaged cells release toxic chemicals into the bloodstream that can cause shock, cardiac arrest, and irreversible kidney damage. Crush syndrome must be recognized and treated right away following rescue to provide the best possible chances of recovery.

A person is most likely to experience crush syndrome if a large body part, such as an arm or leg, is trapped for more than an hour. Oxygen-deprived muscle fibers break and leak potassium, myoglobin, and other substances into nearby blood vessels. When the crushing force is removed, those chemicals enter circulation and travel throughout the body. The sudden increase in potassium levels in the blood can disrupt heart rhythm and possibly induce cardiac arrest. Myoglobin is toxic to the kidneys and can lead to total renal failure.

The symptoms of crush syndrome can vary depending on the nature of the traumatic event and the extent of the injury. Many patients are responsive, albeit in a lot of pain, when they are initially rescued. As toxic chemicals enter circulation in the minutes and hours after rescue, their conditions may quickly decline. Extreme weakness, rapid breathing, and mental confusion are common. A person may slip in and out of consciousness and show signs of very low blood pressure. Emergency medical care and constant vital sign monitoring are essential whenever crush syndrome is suspected.

Treatment for crush syndrome usually begins as soon a patient is rescued. Emergency responders are trained to provide life-saving oxygen therapy, cardiopulmonary resuscitation, and other treatment measures until a patient arrives at a hospital. Once admitted, doctors test blood and urine samples for unusual quantities of myoglobin and potassium and assess the overall condition of the patient. Intravenous fluids and diuretics are usually provided to flush toxins out of the kidneys and reduce the chances of renal failure. If necessary, a defibrillator is used to restart the heart or return it to normal rhythm.

Most patients who experience crush syndrome need to stay in the hospital for several days so doctors can monitor their conditions. Injuries to bones, muscles, and other structures are treated appropriately with medications or surgery. In the case of severe damage, a body part may need to be amputated to prevent further complications. With ongoing care and physical therapy, many people are able to fully recover from their injuries.

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Discussion Comments
By burcinc — On May 24, 2011

@ddljohn-- Hey, I believe the critical time period is around four hours for crush syndrome. Muscles and cells can pretty much preserve themselves for four hours. But if it is longer than that and blood flow doesn't start, the cells start to die.

That's why it is so important to rescue people as soon as possible after disasters. The longer they remain in that position, the higher the risks.

By ddljohn — On May 23, 2011

I'm glad to know that crush syndrome can be treated. I had the impression that all of these injuries resulted in amputation, and also when there is freezing.

Are the complications that come with crush syndrome same as when a limb freezes?

And how long does it take for cells to start dying? Like if someone is crushed by rubble but is saved after two hours, will they still have crush syndrome?

Thanks!

By fify — On May 22, 2011

Apparently, the crush syndrome wasn't very well recognized in the medical community and disaster relief until World War II. I have been reading about relief and rescue efforts during wartime and natural disasters for a project I am working on.

I noticed that in World War I, crush syndrome was not reported at all. I found reports about it beginning with World War II. Bombings, earthquakes and collapse of improperly built buildings appear to be the main cause.

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