Summit on Exercise Collapse Associated with Sickle Cell Trait: Finding the “Way Ahead”

Abstract

Although largely benign, sickle cell trait (SCT) has been associated with exertion-related events, to include sudden death. In 2011, a summit on SCT introduced the term exercise collapse associated with SCT (ECAST). A series of ECAST deaths in military personnel in 2019 prompted reevaluation of current efforts and led to a second summit in October 2019 hosted by the Consortium for Health and Military Performance of the Uniformed Services University in Bethesda, MD. The goals were to (1) review current service policies on SCT screening, (2) develop draft procedural instructions for executing current policy on SCT within the Department of Defense, (3) develop draft clinical practice guidelines for management of ECAST, (4) establish a framework for education on SCT and ECAST, and (5) prepare a research agenda to address identified gaps.

Athlete Preparticipation Physical Evaluation

“…Athletes with SCT are at higher risk for ECAST when at higher elevations (above 1500 m), high heat, humidity, and intense exercise, particularly with lack of acclimatization. 21,22 Universal screening is not routinely recommended for all athletes, but NCAA athletes are required to show proof of screening or decline screening. 7 There is evidence that screening may reduce SCT-related death.…”

ECAST Syndrome (Exercise Collapse Associated with Sickle Cell Trait): First Knock of Sickle Cell in a Young Bodybuilder

“…If collapse occurs in an athlete with AS Pattern following exercise, it is referred to as ECAST. It is important to identify and treat ECAST as it causes the risk of death to increase by 40 times in athletes with sickle cell trait when compared to other athletes [2]. Early diagnosis and treatment of ECAST prevents mortality and reduces the complications associated with this rare syndrome [2].…”

Sickle Cell Trait at High Altitudes as a Response to Summit on Exercise Collapse Associated with Sickle Cell Trait: Finding the “Way Ahead”

“…As awareness of catastrophic sickle cell trait (SCT)-related deaths in military service members has grown, Dr. Francis O’Connor and the Consortium for Health and Military Performance published “Summit on Exercise Collapse Associated with Sickle Cell Trait: Finding the 'Way Ahead'”, in 2021 to provide education, outline practice guideline updates, and identify gaps concerning this at-risk population (1). High altitude was briefly addressed in this article.…”

“…Currently, no definitive guidelines exist for altitude acclimatization for patients with SCT. General guidelines suggest elevation-specific acclimatization (1). Army Technical Bulletin 505 recommends a staged ascent protocol, which pairs elevation of ascent with time at that elevation needed to minimize illness symptoms.…”