Cooling methods used in the treatment of exertional heat illness

J E Smith

Correspondence to:
Correspondence to:
Dr Smith
Emergency Department, Derriford Hospital, 4 Fort Terrace, Plymouth PL6 5BU, UK; jasonesmith{at}doctors.org.uk

Objective: To review the different methods of reducing body core temperature in patients with exertional heatstroke.

Methods: The search strategy included articles from 1966 to July 2003 using the databases Medline and Premedline, Embase, Evidence Based Medicine (EBM) reviews, SPORTDiscus, and cross referencing the bibliographies of relevant papers. Studies were included if they contained original data on cooling times or cooling rates in patients with heat illness or normal subjects who were subjected to heat stress.

Results: In total, 17 papers were included in the analysis. From the evidence currently available, the most effective method of reducing body core temperature appears to be immersion in iced water, although the practicalities of this treatment may limit its use. Other methods include both evaporative and invasive techniques, and the use of chemical agents such as dantrolene.

Conclusions: The main predictor of outcome in exertional heatstroke is the duration and degree of hyperthermia. Where possible, patients should be cooled using iced water immersion, but, if this is not possible, a combination of other techniques may be used to facilitate rapid cooling. There is no evidence to support the use of dantrolene in these patients. Further work should include a randomised trial comparing immersion and evaporative therapy in heatstroke patients.

Keywords: cooling methods; heat illness; heat stroke

ORIGINAL ARTICLE

Cooling methods used in the treatment of exertional heat illness

J E Smith

Correspondence to:
Correspondence to:
Dr Smith
Emergency Department, Derriford Hospital, 4 Fort Terrace, Plymouth PL6 5BU, UK; jasonesmith{at}doctors.org.uk

Objective: To review the different methods of reducing body core temperature in patients with exertional heatstroke.

Methods: The search strategy included articles from 1966 to July 2003 using the databases Medline and Premedline, Embase, Evidence Based Medicine (EBM) reviews, SPORTDiscus, and cross referencing the bibliographies of relevant papers. Studies were included if they contained original data on cooling times or cooling rates in patients with heat illness or normal subjects who were subjected to heat stress.

Results: In total, 17 papers were included in the analysis. From the evidence currently available, the most effective method of reducing body core temperature appears to be immersion in iced water, although the practicalities of this treatment may limit its use. Other methods include both evaporative and invasive techniques, and the use of chemical agents such as dantrolene.

Conclusions: The main predictor of outcome in exertional heatstroke is the duration and degree of hyperthermia. Where possible, patients should be cooled using iced water immersion, but, if this is not possible, a combination of other techniques may be used to facilitate rapid cooling. There is no evidence to support the use of dantrolene in these patients. Further work should include a randomised trial comparing immersion and evaporative therapy in heatstroke patients.

Keywords: cooling methods; heat illness; heat stroke

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Commentary

L Wallis

University of Cape Town, PO Box 901, Wellington 7654, South Africa; leewallis{at}bvr.co.za

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