Electrocardiographic changes of patients who were under the rubble and were admitted to the hospital during Kahramanmaraş Earthquake

Yıl 2024, , 270 - 277, 27.05.2024

Süleyman Akkaya , Ümit Çakmak

https://doi.org/10.32322/jhsm.1453520

Öz

Aims: In this study, we aimed to determine the electrocardiographic findings in earthquake victims who were admitted to our hospital after the Kahramanmaraş earthquake.
Methods: We included all patients who applied to Diyarbakır Gazi Yaşargil Training and Research Hospital as earthquake victims in the study. The total number of injured patients removed from the rubble after the earthquake and admitted to our hospital was 321. A total of 139 patients were admitted to our hospital for examination and treatment. Fourty of them have a electrocardiograhphy. Clinical characteristics of the patients were compared according to the presence of crush syndrome. Patients
who received further treatment in the intensive care unit (ICU) were compared with patients who did not require intensive care in terms of clinical characteristics. Electrocardiograpghy (ECG) findings were presented in all groups.
Results: Crush syndrome developed in 45% of patients, while 25% developed acute renal failure. As expected, compartment syndrome was more common in patients with crush syndrome (66.7% vs 18.2%, p=0.002). The proportion of patients requiring dialysis treatment was 12.5% (n=5). The proportion of patients who received further treatment in the intensive care unit was 35% (n=14). In terms of ECG characteristics, heart rate was higher in ICU-treated patients (105/min vs 86/min, p<0.001), PR interval was longer in ICU-treated patients (0.2 s vs 0.14 s), QRS complex was shorter in ICU-treated patients (0.05 mm vs 0.077 mm, p=0.021). QT interval was shorter in patients who admitted to intensive care unit (0.33 vs 0.35, p=0.021). In patients with crush syndrome, PR interval was longer (0.17 vs 0.16, p=0.006), QRS width was shorter (0.06 vs 0.072, p=0.021). In addition, the T-amplitude in the ECG was found to be higher in those who developed acute kidney injury compared to those who did not (0.20 vs. 0.10, p=0.018). Again, the T-amplitude was higher in those who required dialysis treatment (0.20 vs. 0.10, p=0.009).
Conclusion: In this study, we demonstrated some possible ECG changes such as PR prolongation and narrow QRS in earthquake victims admitted to our hospital. ECG can be used as a simple but predictive tool to monitor cardiovascular outcomes in earthquake victims.

Anahtar Kelimeler

Crush syndrome, electrocardiography, electrocardiographic findings

Kaynakça

• Ren C, Wang Z, Taymaz T, et al. Supershear triggering and cascading fault ruptures of the 2023 Kahramanmaraş, Türkiye, earthquake doublet. Science. 2024;383(6680):305-311.
• Brunckhorst CB, Holzmeister J, Scharf C, Binggeli C, Duru F. Stress, depression and cardiac arrhythmias. Ther Umsch. 2003; 60(11):673-681.
• Leor J, Poole K, Kloner RA. Sudden cardiac death triggered by an earthquake. NEJM. 1996;334(7):413-419.
• He Q, Wang F, Li G, et al. Crush syndrome and acute kidney injury in the Wenchuan Earthquake. J Trauma. 2011;70(5):1213-1218.
• Better OS, Abassi Z, Rubinstein I, Marom S, Winaver Y, Silberman M. The mechanism of muscle injury in the crush syndrome: ischemic versus pressurestretch myopathy. Miner Electrolyte Metab. 1990;16(4):181-184.
• Better OS. The crush syndrome revisited (1940–1990). Nephron. 1990;55(2):97-103.
• Liu S, Yu Y, Luo B, Liao X, Tan Z. Impact of traumatic muscle crush injury as a cause of cardiomyocyte-specific injury: an experimental study. Heart Lung Circ. 2013;22(4):284-290.
• Guo X, Wang D, Liu Z. Electrocardiographic changes after injury in a rat model of combined crush injury. Am J Emerg Med. 2013;31(12):1661-1665.
• Acıpayam A, Eser N, Yaylalı A, et al. Effects of amifostine against blunt chest trauma-induced cardiac injury in rats. Turkish J Trau Emerg Surg. 2023;29(3):266-276.
• Yamaoka-Tojo M, Tojo T. Prevention of natural disaster-induced cardiovascular diseases. J Clin Med. 2024;13(4):1004.
• Sarı H, Özel M, Akkoç MF, Şen A. First-week analysis after the turkey earthquakes: demographic and clinical outcomes of victims. Prehosp Disaster Med. 2023;38(3):294-300.
• Koyuncu S, Sipahioglu H, Bol O, et al. The evaluation of different treatment approaches in patients with earthquake-related crush syndrome. Cureus. 2023;15(10):e47194.
• Döven SS, Tezol Ö, Yeşil E, et al. The 2023 Türkiye-Syria earthquakes: analysis of pediatric victims with crush syndrome and acute kidney injury. Pediatr Nephrol. Published online February 15, 2024.
• Erdem K, Duman I, Ergün R, Ergün D. The correlation between electrocardiographic parameters and mortality in non-cardiac ICU patients. Eur Rev Med Pharmacol Sci. 2023;27(14):6662-6670.
• George TK, Chase D, Peter JV, et al. Association between a prolonged corrected QT interval and outcomes in patients in a medical intensive care unit. Indian J Crit Care Med. 2015; 19(6):326-332.
• Ozdemir R, Isguder R, Kucuk M, et al. A valuable tool in predicting poor outcome due to sepsis in pediatric intensive care unit: Tp-e/QT ratio. J Trop Pediatr. 2016;62(5):377-384.
• Montague BT, Ouellette JR, Buller GK. Retrospective review of the frequency of ECG changes in hyperkalemia. Clin J Am Soc Nephrol. 2008;3(2):324.
• Akmal M, Bishop JE, Telfer N, Norman AW, Massry SG. Hypocalcemia and hypercalcemia in patients with rhabdomyolysis with and without acute renal failure. J Clin Endocrinol Metab. 1986;63(1):137.
• Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine. 1982;61(3):141.