Crush Injuries, Compartment Syndrome
and other Acute Traumatic Ischemias

Hyperbaric Oxygen Therapy Approval Status

Yes Clearance by US Food and Drug Administration (FDA)

Yes Approval by the Undersea and Hyperbaric Medical Society (UHMS)

About Clearance and Approval

 

Definition and Causes

A traumatic ischemia is a condition of inadequate supply of blood to organs and body tissues as a result of a severe physicial injury. Crush injuries and compartment syndrome are traumatic ischemias associated with complex wounds resulting from such traumatic injuries.

Great weight, severe blows, gunshots, or automobile and other accidents may cause crush injuries, which are compressions of the extremities or other parts of the body. Crush injuries commonly cause muscle swelling and neurologic problems. Cellular damage and damaged blood vessels are also typical. Complications include infections, nonhealing bone fractures, and amputation.

Note: crush injuries, which effect a portion of the body such as a leg, are different from crush syndrome, in which the local compression injury is accompanied by a systemic problem such as shock or kidney failure.

In anatomical terms, a compartment is a section of the body containing muscles and nerves which is surrounded by connective tissue (fascia). The arms and legs each have an upper and lower compartment.

Acute compartment syndrome is a medical emergency in which serious injury causes severe high pressure within the anatomical compartment, disrupting the blood flow in the compartment. Nerve and muscle death may result from the inadequate blood supply (ischemia) if acute compartment syndrome is untreated. Surgery is usually required.

Chronic exertional compartment syndrome is a condition in which blood flow is restricted (ischemia) in muscles as a result of extreme pressure within the muscles brought on by repetitive exercises like running or cycling. Chronic exertional comparment syndrome is typically relieved by ceasing the exercise activity, although persistent symptoms may indicate the need for medicine or surgery.

Evidence Index

Approved
FDA cleared, widely reimbursed
Compelling
Strong body of evidence
Promising
Repeatedly favorable results
Scant
Early or mixed results
None
Unfavorable or no evidence
Disproved
Strong evidence against HBOT

Treatment with Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) improves the circulation of oxygenated blood to wounds to help fight infection, reduce swelling, and promote healing. The 100 percent oxygen environment and increased atmospheric pressure of HBOT increase the supply of oxygen to damaged, ischemic tissues. HBOT also reduces edema (excess fluid) in the affected area, further helping to improve blood flow. Additional benefits occur as the blood supply to damaged tissue improves.

Read the page Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias in the Undersea and Hyperbaric Medical Society Resource library for more about these conditions; the rationale for hyperbaric oxygen therapy; and key clinical evidence, outcomes, and success factors.

HyperbaricLink Commentary

Hyperbaric oxygen therapy (HBOT) is emerging as a promising treatment for crush injury, compartment syndrome, and other acute traumatic ischemias. Unfortunately, at present HBOT is “woefully neglected as an adjunct for managing crush injury and SMCS [skeletal muscle compartment syndrome].” according to the UHMS. This is particularly regrettable in the case of compartment syndrome because “…in its insipient stages before a fasciotomy is required…no means to arrest its progression other than hyperbaric oxygen (HBO2) exist.” [ UHMS, 2015 ]

Traumatic ischemias and Necrotizing Infections, Acute Carbon Monoxide Poisoning, Central Retinal Artery Occlusion and other conditions typically seen in an emergency department are reasons why a fully-equipped trauma center should include hyperbaric oxygen therapy as part of its emergency services portfolio.

Patient Resources

HyperbaricLink recommends the following websites for anyone seeking additional information on crush injuries, compartment syndrome, and other acute traumatic ischemias.

American Trauma Society

The ATS is dedicated to the elimination of needless death and disability from injury. See the Trauma Resources section of their website for helpful information on trauma centers and a directory.

US National Center for Injury Prevention and Control
US Centers for Disease Control (CDC)

The CDC provides an extensive collection of resources focused on preventing many of the types of injuries that cause crush injuries and other traumatic ischemias. The best cure is prevention!

Wikipedia: Compartment Syndrome

The Wikipedia article on compartment syndrome currently covers both acute compartment syndrome and chronic exertional compartment syndrome, differentiating between each and describing diagnosis, treatments, and outcomes.

Wikipedia: Rhabdomyolysis

Crush injuries often involve damage to muscles. Rhabdomyolysis is a condition in which damaged muscle tissue breaks down and can cause kidney failure. Persons injured in earthquakes, construction and mining accidents, bombings, and other events inflicting great pressure on the body are likely to experience rhabdomyolysis.

Clinical Resources

Start with the following resources to explore current research activities and the peer-reviewed medical literature on hyperbaric oxygen therapy for traumatic ischemias.

 Use the search buttons below to go directly to research on hyperbaric oxygen therapy.

Bombings: Injury Patterns and Care
American College of Emergency Physicians

The ACEP website provides an extensive set of resources and links related to the emergency care of blast victims.

American College of Hyperbaric Medicine

The American College of Hyperbaric Medicine (ACHM) is a professional society formed to promote the image of hyperbaric medicine as a distinct medical specialty.

Read the ACHM website page on Acute Peripheral Arterial Insufficiency.

ClinicalTrials.gov
US National Institutes of Health

ClinicalTrials.gov keeps the official list of human clinical trials currently enrolling, in progress, and recently completed. One may reasonably question the size and legitimacy of any study not listed here.

Search ClinicalTrials.gov

Google Scholar

A specialized Google search engine, Google Scholar indexes scholarly articles, patents, and legal opinions and journals. Google Scholar may produce many search results, but entries provide easy access to full-text journal articles.

Search Google Scholar

HBOEvidence

HBOEvidence uses computerized tools to appraise the key randomized controlled trials (RCTs) in the hyperbaric medical literature. One may reasonably question the overall strength of HBOT evidence for any disease or condition not covered here.

Search HBOEvidence

PubMed.gov
US National Library of Medicine, US National Institutes of Health

PubMed keeps the official list of scientific papers published in reputable peer-reviewed medical journals. One may reasonably question the importance and legitimacy of any study not listed here.

Search PubMed.gov

 

News About Traumatic Ischemias and Hyperbaric Oxygen Therapy

Sources
Undersea & Hyperbaric Medical Society, Indications, Crush Injury. Retrieved 02 May 2015.
www.uhms.org/4-crush-injury-compartment-syndrome-and-other-acute-traumatic-ischemias.html
Page Data
Updated: 01 Aug 2015 08:01 PM
Created: 13 Jun 2009 12:00 AM
By: About the authors »