Asphyxiation: a review

Accidental compression of the thoracic wall. Mechanical asphyxia rather than trauma is the main culprit

We present three cases of traumatic asphyxia after thoracic compression. All victims were Caucasian males aged 22-50 years. One man was crushed by a truck trailer, another was crushed by an overturned vehicle, and the last was crushed by a large heavy stone slab. None of the patients survived the accident. There was no evidence of trauma or only minor trauma from the bones or vital organs of the thoracic cavity and abdomen.

Therapeutic efficacy for traumatic asphyxia with a focus on cardiac arrest

Aim

To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac arrest and therapeutic efficacy. This review will be useful for future emergencies.

Methods

Sixteen traumatic asphyxia cases from our hospital between April 2007 and March 2019 were reviewed and divided into three groups: those experiencing cardiac arrest at the time of rescue (group A, six cases), those experiencing cardiac arrest after rescue (group B, five cases), and those who did not experience cardiac arrest (group C, five cases).

Results

All cases had abnormal findings in the skin or conjunctiva. The total mortality rate reached 56%. Among the 11 cases in groups A and B that resulted in cardiac arrest, 10 had an Injury Severity Score of 16 or higher and an Abbreviated Injury Scale score in the chest of 3 or higher. The patients' injuries included pneumothorax, flail chest, and pericardial hematoma. The heartbeat was restarted in seven cases, and two cases completely recovered.

Conclusion

In some traumatic asphyxia cases, the treatment course was relatively effective even with cardiac arrest; thus, life support efforts should not be spared in such cases.

Compression asphyxia and other clinicopathological findings from the Hillsborough Stadium disaster

Ninety-six people died following a crowd crush at the Hillsborough Football Stadium, Sheffield, UK in 1989. The cause of death in nearly all cases was compression asphyxia. The clinical and pathological features of deaths encountered in crowds are discussed with a particular focus on the Hillsborough disaster.

Traumatic Asphyxia

Traumatic asphyxia is a clinical syndrome related to cervicofascial cyanosis, petechiae, subconjunctival haemorrhages and neurological symptoms. This syndrome occurs after a transient, severe and compressive blunt thoracic trauma. Here, we presented two cases of traumatic asphyxia. They both had prominent petechiae on upper parts of their bodies. The prognosis was excellent in the boy. Contrary, second case was dead in emergency department due to subarachnoid haemorrhage and intracerebral petechial haemorrhages. Traumatic asphyxia alone does not predict morbidity and mortality. It is the concomitant cardiovascular, pulmonary and neurologic injuries that affect the outcome.

Traumatic Asphyxia: A Rare Clinical Syndrome

Traumatic asphyxia is a rare clinical syndrome characterised by cyanosis, oedema and petechial haemorrhage of the face, neck and upper chest due to the sudden, transient and severe thoraco-abdominal compression trauma. The huge increase in intra-thoracic pressure caused by the compression constitutes all the symptoms. Although mortality and morbidity due to traumatic asphyxia can happen, most of the patients survive without any sequel. Herein, we report three cases of traumatic asphyxia assessed in our emergency department. (Hong Kong j.emerg.med. 2014;21:185-188)

Compression asphyxia from a human pyramid

In compression asphyxia, respiration is stopped by external forces on the body. It is usually due to an external force compressing the trunk such as a heavy weight on the chest or abdomen and is associated with internal injuries. In present case, the victim was trapped and crushed under the falling persons from a human pyramid formation for a "Dahi Handi" festival. There was neither any severe blunt force injury nor any significant pathological natural disease contributing to the cause of death. The victim was unable to remove himself from the situation because his cognitive responses and coordination were impaired due to alcohol intake. The victim died from asphyxia due to compression of his chest and abdomen. Compression asphyxia resulting from the collapse of a human pyramid and the dynamics of its impact force in these circumstances is very rare and is not reported previously to the best of our knowledge.

A Case of Traumatic Asphyxia due to Motorcycle Accident

Background. Perthe's syndrome (traumatic asphyxia) is rare, which is caused by sudden compressive chest trauma and characterized by subconjunctival hemorrhage, facial edema, craniocervical cyanosis, and petechiae on the upper chest and face and should always be kept in mind as a possible complication of injuries of the chest and abdomen. Case Report. In this case report a 36-years-old male patient brought to the emergency room due to thorax trauma related to motorcycle accident was discussed. Distinct cyanotic, edematous, and multiple petechiae were present on the face, neck, and upper thorax regions of the patient. Bilateral subconjunctival hemorrhage was determined. Conclusion. Treatment for traumatic asphyxia is supportive and patient recovery is related to the generally associated injuries. Prognosis of the patients is quite good with effective and timely treatment.

Traumatic asphyxia due to blunt chest trauma: a case report and literature review

Introduction

Crush asphyxia is different from positional asphyxia, as respiratory compromise in the latter is caused by splinting of the chest and/or diaphragm, thus preventing normal chest expansion. There are only a few cases or small case series of crush asphyxia in the literature, reporting usually poor outcomes.

Case presentation

We present the case of a 44-year-old Caucasian man who developed traumatic asphyxia with severe thoracic injury and mild brain edema after being crushed under heavy auto vehicle mechanical parts. He remained unconscious for an unknown time. The treatment included oropharyngeal intubation and mechanical ventilation, bilateral chest tube thoracostomies, treatment of brain edema and other supportive measures. Our patient’s outcome was good. Traumatic asphyxia is generally under-reported and most authors apply supportive measures, while the final outcome seems to be dependent on the length of time of the chest compression and on the associated injuries.

Conclusion

Treatment for traumatic asphyxia is mainly supportive with special attention to the re-establishment of adequate oxygenation and perfusion; treatment of the concomitant injuries might also affect the final outcome.