Recent Advances in the Management of Crush Syndrome: From Bench to Bedside

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Background

Crush syndrome (CS) often occurs in victims of disasters such as earthquakes, traffic accidents, and warfare. CS is defined as a condition in which rhabdomyolysis develops after extrication from prolonged continuous pressure on limb skeletal muscles by heavy debris and the subsequent release of toxic substances into the bloodstream from re-perfused muscle tissues, leading to acute respiratory distress syndrome (ARDS), circulatory shock, metabolic acidosis, and acute renal failure (ARF). Despite the immediate start of treatment in the prehospital setting, such as intravenous fluid administration to correct hypovolemia, electrolyte abnormalities, and acidosis, prompt fasciotomies to suppress compartment syndrome, and prehospital tourniquet application to delay reperfusion injury, there is not yet a definitive on-site treatment; even amputation of injured extremities must be chosen for lifesaving when extrication is delayed. Developing CS treatment is urgently required when considering, for example, earthquake disasters that frequently occur around the world; however, due to the unfeasibility of human studies, animal models have been used both to clarify pathogenesis and pathophysiology of CS and to develop new therapeutic strategies. The research in this field has steadily progressed to pursuing new drug applications to skeletal muscle ischemia/reperfusion injury and the subsequent systemic inflammation, ARDS, and ARF.

Although the reports on therapeutic strategies published so far are based mainly on animal experiments, their applications to humans are of great interest. This Research Topic welcomes your manuscript dealing with recent progress in basic and clinical research on CS, including animal models, experimental protocols, and drug interventions with their therapeutic effects.

We look forward to fruitful discussions on this Research Topic and call for both original articles and reviews, which would provide the readers of Frontiers in Pharmacology with new findings and comprehensive elucidation about the etiology, mechanism, and symptoms of CS, which may lead to future therapeutic strategies in clinical practice. This issue will focus on but is not limited to, the following topics :

• Elucidation of the pathophysiology of crush syndrome

• Development of animal models for the study of crush syndrome

• Development of new pharmacological treatment strategies for crush syndrome

Keywords: Crush syndrome, ischemia/reperfusion injury, nitric oxide, rhabdomyolysis, acute respiratory distress syndrome, acute renal failure

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