Blood Purification for Crush Syndrome

Abstract

At least 372 people developed crush syndrome after they were injured by the Great Hanshin-Awaji Earthquake. Of these, 23 were transferred to Osaka City General Hospital from the disaster area. The serum creatinine kinase (CK) of each of the 23 patients exceeded 10,000 IU/L. Sixteen of these patients were treated with various methods of blood purification including hemodialysis (HD), plasma exchange (PE), and continuous hemodiafiltration (CHDF). The effectiveness on each method of blood purification was evaluated in this study based on the clearance of myoglobin and the length of time until recovery from acute renal failure (ARF). None of the patients died, and none suffered from ARF longer than 2 months. The length of time required for blood purification was significantly correlated with the serum CK and myoglobin levels on admission. The serum myoglobin levels decreased linearly regardless of the method of blood purification used. Our findings showed that the severity of ARF that occurred in association with crush injury was proportional to the amount of crushed muscle and that once ARF had developed, the clearance of myoglobin was not affected by any of the blood purification methods tested including HD, PE, and CHDF. Therefore, the method of blood purification employed for crush syndrome should be selected for its effectiveness in treating ARF, rather than the elimination of myoglobin.

Crush syndrome patients after the Marmara earthquake

“…7 The serum myoglobin concentrations decreased linearly regardless of the method of blood purification used. 22 Fasciotomy had been performed in seven patients without peripheral pulse as assessed with Doppler flowmetry. Six of these patients were mechanically ventilated.…”

Prevention of acute kidney injury and protection of renal function in the intensive care unit

“…However, it should be emphasized that fomepizole should be used as a firstline treatment before attempting extracorporeal therapy in cases of ethylene glycol intoxication as well as rasburicase following adequate volume expansion in order to prevent tumor lysis syndrome before consideration of extracorporeal therapy. Similarly, the use of extracorporeal techniques to remove myoglobin will require membranes with a high cutoff [266], possibly used in series for a minimal duration of 6 h, which is not readily available [267][268][269][270][271][272][273]. Four studies have evaluated leukodepletion during cardiopulmonary bypass [274][275][276][277], with three suggesting a beneficial effect on renal function [274][275][276].…”

In-Vitro Myoglobin Clearance by a Novel Sorbent System

“…Newer, high-flux membranes are much more effective in clearing circulating myoglobin from the blood [2,3]. However, some studies have found that dialysis or hemoperfusion even with the high-permeability membranes does not always cause a substantial fall in myoglobin levels [10,11]. Additionally, in those cases of effective clearance of myoglobin from blood by high-or ultra-high-flux membranes, the final plasma myoglobin levels were not reduced below 16,000 ng/ml, which may still be high enough to affect renal function [3,12].…”