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Heat stroke is an emergent condition characterized by hyperthermia (>40 °C/>104 °F) and nervous system dysregulation. There are two primary etiologies – exertional—during physical activity, and non-exertional—during extreme heat events without physical exertion. If left untreated, both may lead to significant morbidity and are considered a special circumstance for cardiac arrest and cause of mortality.
The goal of a new study published in Resuscitation was to investigate the first-aid cooling techniques which are effective for managing heat stroke and exertional hyperthermia
This systematic review and meta-analysis entailed searches from Medline, Embase, CINAHL and SPORTDiscus. Randomized controlled trials (RCTs), non-randomized trials, cohort studies and case series comprising five or more patients that evaluated adults and children with non-exertional or exertional heat stroke or exertional hyperthermia, and any cooling technique applicable to first aid and prehospital settings, were selected. Outcomes included: cooling rate, mortality, neurological dysfunction, adverse effects and hospital length of stay.
Overall, 63 studies – 37 controlled studies, two cohort studies and 24 case series of heat stroke patients, were included. The results showed that water immersion of adults with exertional hyperthermia – cold water (14-17 °C/57.2-62.6 °F), colder water (8-12 °C/48.2-53.6 °F) and ice water (1-5 °C/33.8-41 °F), resulted in faster cooling rates than passive cooling. Meanwhile, no single water temperature range was found to be associated with a quicker core temperature reduction than another (cold, colder or ice).
The findings suggested that water immersion techniques using 1-17 °C water, more effectively lowered core body temperatures when compared to passive cooling in hyperthermic adults. Thus, it was inferred that water immersion can rapidly reduce core body temperature in settings where it is feasible.
Source: Resuscitation. 2020 Mar 1;148:173-190. doi: 10.1016/j.resuscitation.2020.01.007.