(246) Management of Earthquake-Related Crush Injury Patients in ICU: The February 6 Earthquake in Turkey

Introduction: On February 6, 2023, a devastating earthquake struck the southeastern region of Turkey, resulting in thousands of injuries and deaths. The objective of the study was to analyze the characteristics, treatment, and clinical outcomes of critically ill patients with crush injuries in the Intensive Care Unit (ICU).

Methods: This study was conducted using a cross-sectional retrospective design in the ICU in Turkey. The patients included in the study were those who were affected by the February 6 earthquake, required ICU treatment, and had crush syndrome. All the data were recorded in the patients' charts and the hospital's electronic medical system.

Results: A total of 62 patients were included in the study. The average age was 41±19 years and 47% were male. The median APACHE II score for the patients was 14 (IQR: 7-23). The most common reason for admission to the ICU was multitrauma and crush injury, which accounted for 82% of cases. The median values for creatinine, creatinine kinase (CK), and myoglobulin levels upon admission were 1.8 mg/dl (with an interquartile range of 0.8-4.1), 15470.0 U/L (IQR: 2832.5-56638.0), and 3000.0 ng/ml (IQR: 1242.5-15438.8), respectively. Upon admission to the ICU, 92% of patients received antibiotic therapy, while all patients received anticoagulant treatment (such as heparin, DMAH, and pneumatic compression socks). Additionally, 79% of patients received 0.9% NaCl, 48% received bicarbonate, and 15% received mannitol. A total of 77% of patients required surgical procedures, with the majority of them undergoing extremity surgery (36%) and fasciotomy (36%) due to compartment syndrome. Furthermore, 24% of patients underwent extremity amputations. Acute kidney injury (AKI) developed in 65% of patients, and 25 (40%) patients required renal replacement therapy, with 21 patients undergoing IHD and 4 patients undergoing CVVHDF. The median length of stay in the ICU was 6 days (with an interquartile range of 3-9), while the median length of hospital stay was 20 days (IQR: 12-35). The 28-day mortality rate was 13%.

Conclusions: As a consequence of the study, the majority of the patients required surgical operations, and 25% of the patients needed to have a limb amputated. AKI was observed at a significant rate, with 40% of those patients requiring renal replacement therapy.