Cooling the crisis: Therapeutic hypothermia after sickle cardiac arrest

Objective: The management of patients with sickle-cell disease and cardiac arrest presents special challenges. Mild therapeutic hypothermia may improve survival and neurologic outcome after cardiac arrest, however, it may also precipitate sickling in patients with sickle-cell disease. Rigorous exchange transfusion may enable mild therapeutic hypothermia after cardiac arrest in patients with sickle-cell disease. Design: Case report. Setting: A 28-bed closed format intensive care unit in a university hospital. Patient: A 41-yr-old man with a double-heterozygous sickle-cell beta-0 thalassemia was admitted to the internal ward for acute chest syndrome. On the third day he developed cardiac arrest. Return of spontaneous circulation was achieved after 45 mins of full cardiopulmonary resuscitation. Interventions: Postcardiac arrest rigorous exchange transfusion and mild therapeutic hypothermia were applied. Measurement and Main Result: Erythrocytapheresis lowered the content of hemoglobin S to 5.6%, and therapeutic hypothermia was successfully maintained for 24 hrs without adverse events. After 2 critical weeks, the patient regained full consciousness. Conclusion: Therapeutic hypothermia after cardiac arrest is feasible following rigorous exchange transfusion in patients with sickle-cell disease. (Crit Care Med 2012; 40:651-653)