Pre-hospital fluid resuscitation and return of spontaneous circulation in earthquake victims with cardiac arrest during the first 24 hours after the 2023 Kahramanmaraş earthquakes: Implications for disaster risk management.

BACKGROUND: Earthquakes can cause crush injuries and post-extrication deaths. Hyperkalemia, metabolic acidosis, hypovolemia, and circulatory failure are key mechanisms of cardiac arrest in victims at risk of crush syndrome. Although intravenous fluid resuscitation is recommended in disaster care, evidence on resuscitation outcomes remains limited. This study evaluated earthquake victims with cardiac arrest during the first 24 h after the 2023 Kahramanmaraş earthquakes and examined the association between pre-hospital fluid resuscitation, admission metabolic parameters, and return of spontaneous circulation (ROSC).

METHODS: This single-center retrospective study was conducted in the emergency department of a tertiary hospital in Mersin, Türkiye. Adult earthquake victims admitted within the first 24 h who developed cardiac arrest before or after emergency department arrival were included. Patients with fatal head, thoracic, or abdominal injuries or missing data were excluded. Initial admission blood gas values were analyzed. The primary outcome was ROSC.

RESULTS: Thirty-seven patients were included. The mean age was 49.30±18.63 years, and 20 patients (54.1%) were female. Pre-hospital fluid resuscitation was administered to 25 patients (67.6%), with a mean volume of 1540±611 mL. Patients receiving fluids had higher pH and lower lactate, potassium, and base excess values. ROSC occurred in 10 patients (27.0%), all of whom had received fluids (p=0.010).

CONCLUSION: Pre-hospital fluid resuscitation was associated with a more favorable metabolic profile and higher ROSC rates in earthquake-related cardiac arrest. These findings support field-based fluid resuscitation and hyperkalemia management in disaster response planning; however, causality cannot be inferred.