Acute Health Effects and Outcome Following Sarin Gas Attacks in Khan Shaykhun, Syria

Background In 2017, Idlib, Syria, was exposed to a chemical attack with sarin gas. Many patients of the attack were presented to the Al Rahman Charity Hospital in northern Syria. The aim of this study is to describe the clinical manifestations of sarin gas exposure, as well as the management and outcome of these manifestations in areas with poor healthcare infrastructure. Methods In a case series study design, medical records of suspected sarin exposed patients were reviewed in terms of age, gender, initial clinical presentation, management, and outcome. Results Seventeen patients with signs of sarin gas exposure had detailed medical records. The mean age was 29.1 years with a range of 4-70 years. Six patients were male (35.3%), and four (23.5%) were children under 18 years. At initial presentation, all victims suffered from respiratory distress because of severe airway inflammation, chest pain, and ophthalmological symptoms. All patients featured varying degrees of intestinal, neurologic, and dermatological signs and symptoms. Acute symptom management consisted of oxygen (100% of patients), atropine (100%), bronchodilators (82.4%), dexamethasone (82.4%), anti-emetics (82.4%), paracetamol (47.1%), and ranitidine (41.2%). Rapid symptomatic recovery was observed in 13 patients (76.5%) who stayed in the hospital for less than 24 hours, but four patients (23.5%) had to be admitted for more than 24 hours. The median length of stay was 22.2 hours (with a range of eight to 48 hours). Two patients required intensive care. Of the studied sample, all patients survived. Interpretation This study demonstrates that even in austere healthcare settings, survival rate and prognosis of sarin gas contaminated patients are fair if basic measures and symptomatic treatment are performed. The study provides insight into the clinical presentation, management, and hospital course likely to result from future sarin gas releases.