Should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries?
Background. The most common medical sequelae after earthquakes are crush injuries and syndromes that require urgent and well-organized care, which further complicates the approach in the face of overstretched resources. The 2023 Kahramanmaraş earthquake, with a magnitude of 7.7, was one of the larg...
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| Format: | Article |
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Hacettepe University Institute of Child Health
2025-02-01
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| Series: | The Turkish Journal of Pediatrics |
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| Online Access: | https://turkjpediatr.org/article/view/4577 |
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| author | Murat Tanyıldız Ömer Özden Karya Şenköylü İlker Eren Aysu Çakar Laşin Özbek Aslıcan Çakkalkurt Ilmay Bilge |
| author_facet | Murat Tanyıldız Ömer Özden Karya Şenköylü İlker Eren Aysu Çakar Laşin Özbek Aslıcan Çakkalkurt Ilmay Bilge |
| author_sort | Murat Tanyıldız |
| collection | DOAJ |
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Background. The most common medical sequelae after earthquakes are crush injuries and syndromes that require urgent and well-organized care, which further complicates the approach in the face of overstretched resources. The 2023 Kahramanmaraş earthquake, with a magnitude of 7.7, was one of the largest disasters in Türkiye, affecting 11 cities with a population of about 13.5 million people and claiming more than 50,000 deaths. Approximately 4.6 million pediatric patients were affected, with over 500 children undergoing amputations. The overwhelming number of cases rendered further treatment efforts nearly unfeasible.
Cases. Here we present three cases of severe crush injuries in which amputation was initially considered in both primary and our tertiary centers but was prevented by a protocol that included therapeutic plasma exchange (TPE) and intensive hyperbaric oxygen treatments (HBOT). Based on our review of the literature, this appears to be the first case series documenting the use of therapeutic plasma exchange (TPE) in the management of crush injury.
Conclusion. In extremities at risk for amputation, TPE therapy is crucial to preventing disseminated intravascular coagulation, systemic inflammatory response syndrome, and the accompanying multiorgan failure. It has been shown that extremities at risk for amputation due to poor perfusion can be managed confidently during the safe recovery period of daily TPE therapy with frequent HBOT, anticoagulant and vasodilator treatments, frequent wound care to prevent the development of infection, prophylactic antibiotics, vacuum-assisted closure therapy, and debridement when necessary.
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| format | Article |
| id | doaj-art-0a0f8133a23348aeae768c6c09bc9ddc |
| institution | OA Journals |
| issn | 0041-4301 2791-6421 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Hacettepe University Institute of Child Health |
| record_format | Article |
| series | The Turkish Journal of Pediatrics |
| spelling | doaj-art-0a0f8133a23348aeae768c6c09bc9ddc2025-08-20T02:01:50ZengHacettepe University Institute of Child HealthThe Turkish Journal of Pediatrics0041-43012791-64212025-02-0167110.24953/turkjpediatr.2025.4577Should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries?Murat Tanyıldız0https://orcid.org/0000-0001-8804-032XÖmer Özden1https://orcid.org/0000-0003-0297-5250Karya Şenköylü2https://orcid.org/0009-0009-0243-5925İlker Eren3https://orcid.org/0000-0003-2965-7690Aysu Çakar4https://orcid.org/0009-0004-0510-4295Laşin Özbek5https://orcid.org/0000-0002-2828-555XAslıcan Çakkalkurt6https://orcid.org/0000-0002-9520-6225Ilmay Bilge7https://orcid.org/0000-0002-4852-989XDepartment of Pediatric Intensive Care, Faculty of Medicine, Koç University, İstanbul, TürkiyeDepartment of Pediatric Intensive Care, Faculty of Medicine, Koç University, İstanbul, TürkiyeDepartment of Pediatric Intensive Care, Faculty of Medicine, Koç University, İstanbul, TürkiyeDepartment of Orthopedics and Traumatology, Faculty of Medicine, Koç University, İstanbul, TürkiyeDepartment of Pediatric Intensive Care, Faculty of Medicine, Koç University, İstanbul, TürkiyeDepartment of Pediatric Intensive Care, Faculty of Medicine, Koç University, İstanbul, TürkiyeDepartment of Undersea and Hyperbaric Medicine, Koç University Hospital, İstanbul, TürkiyeDepartment of Pediatric Nephrology, Faculty of Medicine, Koç University, İstanbul, Türkiye Background. The most common medical sequelae after earthquakes are crush injuries and syndromes that require urgent and well-organized care, which further complicates the approach in the face of overstretched resources. The 2023 Kahramanmaraş earthquake, with a magnitude of 7.7, was one of the largest disasters in Türkiye, affecting 11 cities with a population of about 13.5 million people and claiming more than 50,000 deaths. Approximately 4.6 million pediatric patients were affected, with over 500 children undergoing amputations. The overwhelming number of cases rendered further treatment efforts nearly unfeasible. Cases. Here we present three cases of severe crush injuries in which amputation was initially considered in both primary and our tertiary centers but was prevented by a protocol that included therapeutic plasma exchange (TPE) and intensive hyperbaric oxygen treatments (HBOT). Based on our review of the literature, this appears to be the first case series documenting the use of therapeutic plasma exchange (TPE) in the management of crush injury. Conclusion. In extremities at risk for amputation, TPE therapy is crucial to preventing disseminated intravascular coagulation, systemic inflammatory response syndrome, and the accompanying multiorgan failure. It has been shown that extremities at risk for amputation due to poor perfusion can be managed confidently during the safe recovery period of daily TPE therapy with frequent HBOT, anticoagulant and vasodilator treatments, frequent wound care to prevent the development of infection, prophylactic antibiotics, vacuum-assisted closure therapy, and debridement when necessary. https://turkjpediatr.org/article/view/4577amputationcrush injuryhyperbaric oxygen treatmenttherapeutic plasma exchangepediatric protocol |
| spellingShingle | Murat Tanyıldız Ömer Özden Karya Şenköylü İlker Eren Aysu Çakar Laşin Özbek Aslıcan Çakkalkurt Ilmay Bilge Should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries? The Turkish Journal of Pediatrics amputation crush injury hyperbaric oxygen treatment therapeutic plasma exchange pediatric protocol |
| title | Should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries? |
| title_full | Should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries? |
| title_fullStr | Should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries? |
| title_full_unstemmed | Should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries? |
| title_short | Should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries? |
| title_sort | should we give priority to plasma exchange and hyperbaric oxygen treatment before deciding on amputation for severe crush injuries |
| topic | amputation crush injury hyperbaric oxygen treatment therapeutic plasma exchange pediatric protocol |
| url | https://turkjpediatr.org/article/view/4577 |
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