Management of Acute Compartment Syndrome
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: ACS and AOFAS
An uncommon cause of extremity compartment syndrome is high-voltage electrical injury, and the diagnosis of ACS in this group is complicated by the associated eschar and the fact that these patients are most-often intubated and cared for in an intensive care unit setting. Biochemical monitoring is therefore of interest in this subset of patients. One moderate quality study (Cancio, 2005) found a weak/poor association between myoglobinuria and the reference standard of fasciotomy (performed based on “clinically evident extremity compartment syndrome or elevated compartment pressures”) for diagnosis of ACS in patients with electrical burn injuries. In relation to this study, neither compartment pressure monitoring nor clinical exam findings have been validated for ACS diagnosis, and treatment standards are biased towards performing fasciotomy/escharotomy. Although there was a weak association between myoglobinuria and performance of fasciotomy in patients with high-voltage electrical injury, the sensitivity and specificity of myoglobinuria are insufficient to recommend it as a diagnostic modality.