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Review
. 2016 Apr;50(4):607-16.
doi: 10.1016/j.jemermed.2015.09.014. Epub 2015 Oct 31.

Cooling Methods in Heat Stroke

Flavio G Gaudio  1 , Colin K Grissom  2
Affiliations
Review

Cooling Methods in Heat Stroke

Flavio G Gaudio et al. J Emerg Med. 2016 Apr.

Abstract

Background: Heat stroke is an illness with a high risk of mortality or morbidity, which can occur in the young and fit (exertional heat stroke) as well as the elderly and infirm (nonexertional heat stroke). In the United States, from 2006 to 2010, there were at least 3332 deaths attributed to heat stroke.

Objective: To summarize the available evidence on the principal cooling methods used in the treatment of heat stroke.

Discussion: Although it is generally agreed that rapid, effective cooling increases survival in heat stroke, there continues to be debate on the optimal cooling method. Large, controlled clinical trials on heat stroke are lacking. Cooling techniques applied to healthy volunteers in experimental models of heat stroke have not worked as rapidly in actual patients with heat stroke. The best available evidence has come from large case series using ice-water immersion or evaporation plus convection to cool heat-stroke patients.

Conclusions: Ice-water immersion has been shown to be highly effective in exertional heat stroke, with a zero fatality rate in large case series of younger, fit patients. In older patients with nonexertional heat stroke, studies have more often promoted evaporative plus convective cooling. Evaporative plus convective cooling may be augmented by crushed ice or ice packs applied diffusely to the body. Chilled intravenous fluids may also supplement primary cooling. Based on current evidence, ice packs applied strategically to the neck, axilla, and groin; cooling blankets; and intravascular or external cooling devices are not recommended as primary cooling methods in heat stroke.

Keywords: conductive cooling; evaporation and convection cooling; exertional heat stroke; heat stroke treatment; nonexertional heat stroke.

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