Crush Injury &

Compartment

Hyperbaric Oxygen Therapy

crushinjuryhero.png

Syndrome

"Treating the 14 conditions covered by OHIP"

Ontario HBOT

What is a Crush Injury?
A crush injury occurs when an injury or accident puts force or pressure on a part of the body. This type of injury most often occurs when two heavy objects squeeze a part of the body between them. You often see crush injuries after a natural disaster, such as an earthquake. If an object, such as a bookcase, falls on top of a person, pinning them down, this can cause a crush injury. Common damage associated with a crush injury includes:
  • Bleeding

  • Bruising

  • Fracture

  • Laceration

  • Nerve Injury

  • Secondary Infection

  • Nerve and Tendon Injuries

  • Rhabdomyolysis

  • Compartment Syndrome

When a crush injury occurs, the longer the person remains under a crushed object, the greater the chance of complications. This includes tissue, muscle, capillary, and nerve damage. As the object puts pressure on the body, it disrupts the flow of blood, starving the area of oxygen. The longer the tissue is deprived of oxygen, the greater the risk of serious damage. If the oxygen deprivation to the muscle lasts too long, muscle tissue begins to die and releases myoglobin into the bloodstream. This results in a condition called Rhabdomyolysis.

This myoglobin travels to the kidneys, where it damages kidney cells. This can lead to kidney damage or kidney failure. Other complications of crush injuries can include osteomyelitis, nonunion of the fracture, failed flap, and amputations. Hyperbaric oxygen, or HBOT, floods the crush injury area with increased levels of oxygen, helping cells and tissue repair and heal.
What is Crush Syndrome?
Also termed rhabdomyolysis, involves a series of metabolic changes produced due to an injury of the skeletal muscles of such a severity as to cause a disruption of cellular integrity and release of its contents into the circulation.
What is Compression Syndrome?

An indirect muscle injury due to a simple, slow compression of a group of muscles leading to ischaemic damage and thus causing crush substances to enter the blood.

What is Compartment Syndrome?

A localized rapid rise of tension within a muscle compartment, which inevitably leads to metabolic disturbances akin to rhabdomyolysis.

Why Hyperbaric Oxygen Therapy?

At high pressures, physically dissolved levels of oxygen increases in the plasma, tissue viability is enhanced, some vasoconstriction occurs and so fluid outflow from the vascular compartments decrease thus reducing tissue edema. It directly assists wound healing by fibroblast proliferation. Finally it can reduce anaerobic bacterial growth in necrosed muscles.

Attenuation of the cycle with oxygen at hyperbaric levels in plasma is, very likely, responsible for improved tissue level perfusion noted experimentally. Observed clinical benefits from intracoronary SuperSaturated oxygen (SSO2) delivery, including infarct size reduction, can be attributed to attenuation of RMI with improvement in microvascular blood flow.

Crush injuries and compartment syndrome are medical emergencies. In crush injuries, care and treatment must begin before you even remove the item causing the injury. Depending on the length of time an area remains in a crushed state, removal of the object can result in immediate complications. Due to the lack of oxygen and blood flow, tissue cells in the crushed area begin to die. As they do this, they release toxins into the crushed area. Therefore, when you remove the item and blood flow resumes, these toxic substances travel throughout the body. If left untreated, a patient can experience rhabdomyolysis, kidney failure, cardiac arrhythmias or cardiac arrest due to increased potassium, respiratory damage, or liver damage.

In cases of compartment syndrome, the immediate course of action is to surgically cut open the fascia. This relieves pressure from the swelling and this surgery is called a fasciotomy. Once doctors release the swelling, the incision is repaired. In some cases, the incision must remain open to keep the pressure down. In this case, a skin graft is often necessary. Hyperbaric oxygen, or HBOT, can help reduce compartment syndrome swelling and complications before a fasciotomy. In many cases, it reduces enough to avoid a fasciotomy.

Crush injury and Rhabdomyolysis

Crush injuries resulting in traumatic rhabdomyolysis are an important cause of acute renal failure. Ischemia reperfusion is the main mechanism of muscle injury. Intravascular volume depletion and renal hypoperfusion, combined with myoglobinuria, result in renal dysfunction. The infusion of intravenous fluids before extrication or soon after injury may lessen the severity of the crush syndrome. Serum CK levels can be used to screen patients with crush injuries to determine injury severity. Once intravascular volume has been stabilized, and the presence of urine flow has been confirmed, a forced mannitol-alkaline diuresis for prophylaxis against hyperkalemia and acute renal failure should be instituted. If an extremity compartment syndrome is suspected, one should have a low threshold for checking the intracompartmental pressures. 

When a crush injury occurs, the longer the person remains under a crushed object, the greater the chance of complications. This includes tissue, muscle, capillary, and nerve damage. As the object puts pressure on the body, it disrupts the flow of blood, starving the area of oxygen. The longer the tissue is deprived of oxygen, the greater the risk of serious damage. If the oxygen deprivation to the muscle lasts too long, muscle tissue begins to die and releases myoglobin into the bloodstream. This results in a condition called Rhabdomyolysis. This myoglobin travels to the kidneys, where it damages kidney cells. This can lead to kidney damage or kidney failure. Other complications of crush injuries can include osteomyelitis, nonunion of the fracture, failed flap, and amputations. Hyperbaric oxygen, or HBOT, floods the crush injury area with increased levels of oxygen, helping cells and tissue repair and heal.

How do I Qualify for OHIP Coverage?

In order to qualify for OHIP covered hyperbaric oxygen therapy for a Chronic Non-Healing Wound, the individual must have access to documentation supporting their diagnosis. A referral from a physician or specialist is preferred, however it is not absolutely necessary. Our medical director will look over all supporting documentation, and make the ultimate decision for qualification.

Additional Literature
The following documents are sourced from respected medical journals regarding compromised skin grafts and flaps, and Hyperbaric Oxygen Therapy (HBOT). 

Please click on the icon to open the PDF in your browser window. If you would like to download the PDF to your computer, right click on the icon and select "save linked file as". 
Reperfusion Microvascular Ischemia After Prolonged Coronary Occlusion: Implications And Treatment With Local Supersaturated Oxygen Delivery Hypoxia (Auckland, N.Z.) Vol. 7 65-79
Published: Oct 2019
Hyperbaric Oxygen Treatment for Failing Facial Flap
Postgrad Medical Journal
Published: January 2007
Hyperbaric Oxygen Therapy for the Compromised Graft or Flap
Adv Wound Care (New Rochelle) 
Published: January 2017