Abstract Introduction Targeted temperature management (TTM) is used to improve neurological outcomes after cardiac arrest. There is limited evidence regarding its efficacy and safety in patients with sickle cell disease (SCD) due to the potential risk hypothermia carries in precipitating vaso-occlusive crises. We present a case of successful TTM in a patient with homozygous SCD(HbSS). Case A 39-year-old female with a past medical history of HbSS and cerebrovascular accident on chronic exchange transfusion therapy suffered a cardiopulmonary arrest secondary due to a food asphyxiation event. She underwent a scheduled red blood cell exchange transfusion prior to this with HgbS decreasing from 56% to 17%. After return of spontaneous circulation was achieved, the decision was made to proceed with TTM for its neuroprotective benefit without performing another exchange transfusion due to the recent successful exchange transfusion. She was cooled to 36 °C for twenty-four hours. Hematology was consulted and recommended a simple transfusion with one unit of packed red blood cells to achieve a goal hemoglobin level of 8 g/dL due to concern for neuro-ischemia in the post-cardiac arrest period. Following termination of TTM, the patient returned to her baseline neurological status of bilateral motor weakness and abulic speech. Her hospital course was complicated by bilateral upper extremity deep vein thromboses secondary to prolonged immobilization requiring therapeutic anticoagulation. She was discharged home on hospital day twenty-one. Discussion There are few documented cases of utilizing cooling protocols in patients with sickle cell disease. In vitro and animal studies suggest hypothermia increases blood viscosity and promotes HbS polymerization, thereby predisposing to vaso-occlusion. There are two other successful cases of TTM following exchange transfusions in the literature, one as part of post-cardiac arrest care and the second during a mitral valve replacement surgery. Clinical guidelines for post-cardiac arrest care do not list SCD as a contraindication to TTM whereas perioperative management guidelines for SCD emphasize strict maintenance of normothermia. This discrepancy highlights the paucity of evidence in post-arrest settings and underscores the importance of individualized decision-making where the neuroprotective benefit of TTM must be weighed against the risk of inducing sickling, with particular consideration given to timing of exchange transfusion. This case illustrates that TTM can be employed safely in SCD patients when preceded by effective exchange transfusion, highlighting the importance of individualized treatment strategies and hematology input. Larger studies are needed to clarify optimal transfusion timing and establish formal protocols. This abstract is funded by: None
Fatima et al. (Fri,) studied this question.