(traumatic asphyxia)

Cerebral anoxia due to compression or crushing of the thorax for at least 2 to 5 minutes. Signs: association of cyanosis in the head and neck, subconjunctival hemorrhages and petechiae in the superior vena cava drainage area.

The most frequent causes are: being crushed during a stampede (e.g., Heysel disaster), deep diving deep, prolonged seizures, rarely a severe asthma attack.

Pathophysiology: the acute increase in intrathoracic pressure, especially if the thorax is in the inspiration phase with a closed glottis, causes venous stasis in zone drained by the superior vena cava with a risk of rupture of capillaries and veins, as well as a decrease in cerebral perfusion pressure; in addition, the absence of respiratory movements causes hypoxemia.

Neurological signs are due to cerebral hypoxia and vary depending on its duration: from simple consciousness disorders to deep coma. Brain imaging is often not contributory (absent or discrete lesions) but may reveal diffuse cerebral edema.

According to the importance, duration and cause of the thoracic compression, one can be observe: rib fractures, pneumo- or hemothorax, myocardial contusion, ARDS, rupture of the diaphragm, retinal exsudate or detachment, intramedullary spinal cord hemorrhage.

Anesthetic implications:

prevention of secondary brain damage: avoid hypoxemia, hypocarbia and systemic hypotension. High level of suspicion of intrathoracic lesions.

References : 

-        El Koraichi A, Benafitou R, Tadili J, Rafii M, El Kharaz H, Al Haddoury M, El Kettani S. 
Syndrome d’asphyxie traumatique ou syndrome de Perthes : à propos de deux observations pédiatriques. 
Ann Fr Anesth Réanim 2012 ; 31 : 259-61.

-         Senoglu M, Senoglu N, Oksuz H, Ispir G. 
Perthes syndrome associated with intramedullary spinal cord hemorrhage in a 4 year-old child : a case report. 
J Cases 2008; 1:17.

-         Chaker K, Khairallah S, Iziki O, Tahouna H, Herrag M. 
Une complication rare de l’asthme aigu grave : le syndrome de Perthes. 
Ann Fr Anesth Réanim 2014 ; 33 : 600-1.

Updated: October 2018