Skip to main content
SpringerLink
Log in

Heat Stroke

A Review of Cooling Methods

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

The prognosis of heat stroke in patients is directly related to the degree of hyperthermia and its duration. Therefore, the most important feature in the treatment of heat stroke is rapid cooling. Several cooling methods have been presented in the literature including immersion in water at different temperatures, evaporative cooling, ice pack application, pharmacological treatment and invasive techniques. This article describes the various cooling techniques in terms of efficacy, availability, adverse effects and mortality rate. Data suggest that cooling should be initiated immediately at time of collapse and should be based on feasible field measures including ice or tepid water (1–16°C), which are readily available. In the emergency department, management should be matched to the patient’s age and medical background and include immersion in ice water (1–5°C) or evaporative cooling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I
Table II
Table III
Table IV
Table V

Similar content being viewed by others

Article Open access 22 May 2018

Toru Hifumi, Yutaka Kondo, … Yasufumi Miyake

References

  1. Bouchama A, Knochel JP. Heat stroke. N Engl J Med, 2002; 346(25): 1978–88

    Article  PubMed  CAS  Google Scholar 

  2. Epstein Y, Sohar E, Shapiro Y. Exertional heat stroke: a preventable condition. Isr J Med Sci 1995; 31: 454–62

    PubMed  CAS  Google Scholar 

  3. Shibolet S, Coll R, Gilat T, et al. Heatstroke: its clinical picture and mechanism in 36 cases. Q J Med 1967; 36: 525–47

    PubMed  CAS  Google Scholar 

  4. Hall DM, Buettner GR, Oberley LW, et al. Mechanisms of circulatory and intestinal barrier dysfunction during whole body hyperthermia. Am J Physiol Heart Circ Physiol 2001; 280(2): H509–21

    PubMed  CAS  Google Scholar 

  5. Bouchama A, Bridey F, Hammami MM, et al. Activation of coagulation and fibrinolysis in heatstroke. Thromb Haemost 1996; 76(6): 909–15

    PubMed  CAS  Google Scholar 

  6. Chang DM. The role of cytokines in heat stroke. Immunol Invest 1993; 22(8): 553–61

    Article  PubMed  CAS  Google Scholar 

  7. Shapiro Y, Rosenthal T, Sohar E. Experimental heat-stroke: a model in dogs. Arch Intern Med 1973; 131: 688–91

    Article  PubMed  CAS  Google Scholar 

  8. Shapiro Y, Seidman DS. Field and clinical observations of exertional heat stroke patients. Med Sci Sports Exerc 1990; 22: 6–14

    PubMed  CAS  Google Scholar 

  9. Buckley IK. A light and electron microscopic study of thermally injured cultured cells. Lab Invest 1972; 26(2): 201–9

    PubMed  CAS  Google Scholar 

  10. Sakaguchi Y, Stephens LC, Makino M, et al. Apoptosis in tumors and normal tissues induced by whole body hyperthermia in rats. Cancer Res 1995; 55(22): 5459–64

    PubMed  CAS  Google Scholar 

  11. Bynum GD, Pandolf KB, Schuette WH, et al. Induced hyperthermia in sedated humans and the concept of critical thermal maximum. Am J Physiol 1978; 235(5): R228–36

    PubMed  CAS  Google Scholar 

  12. Harker J, Gibson P. Heat-stroke: a review of rapid cooling techniques. Intensive Crit Care Nurs 1995; 11(4): 198–202

    Article  PubMed  CAS  Google Scholar 

  13. Sandor RP. Heat illness: on-site diagnosis and cooling. Phys Sportsmed 1997; 25: 35–40

    PubMed  CAS  Google Scholar 

  14. Graham BS, Lichtenstein MJ, Hinson JM, et al. Nonexertional heatstroke: physiologic management and cooling in 14 patients. Arch Intern Med 1986; 146(1): 87–90

    Article  PubMed  CAS  Google Scholar 

  15. Wyndham CH, Strydom NB, Cooke HM. Methods of cooling subjects with hyperpyrexia. J Appl Physiol 1959; 14: 771–6

    PubMed  CAS  Google Scholar 

  16. Weiner JS, Khogali M. A physiological body-cooling unit for treatment of heat stroke. Lancet 1980; I: 507–9

    Article  Google Scholar 

  17. Rowell LB. Human cardiovascular adjustments to exercise and thermal stress. Physiol Rev 1974; 54(1): 75–159

    PubMed  CAS  Google Scholar 

  18. Proppe DW, Brengelmann GL, Rowell LB. Control of baboon limb blood flow and heart rate-role of skin vs core temperature. Am J Physiol 1976; 231 (5 Pt 1): 1457–65

    PubMed  CAS  Google Scholar 

  19. Rowell LB. Cardiovascular aspects of human thermoregulation. Circ Res 1983; 52(4): 367–79

    Article  PubMed  CAS  Google Scholar 

  20. Armstrong LE, Crago AE, Adams R, et al. Whole-body cooling of hyperthermic runners: comparison of two field therapies. Am J Emerg Med 1996; 14: 355–8

    Article  PubMed  CAS  Google Scholar 

  21. Costrini A. Emergency treatment of exertional heatstroke and comparison of whole body cooling techniques. Med Sci Sports Exerc 1990; 22(1): 15–8

    PubMed  CAS  Google Scholar 

  22. Daily WM, Harrison TR. A study of the mechanism and treatment of experimental heat pyrexia. Am J Med Sci 1948; 215: 42–55

    Article  PubMed  CAS  Google Scholar 

  23. Ferris EB, Blankenhorn MA, Robinson HW, et al. Heat stroke: clinical and chemical observations in 44 cases. J Clin Invest 1938; 17: 249–62

    Article  PubMed  CAS  Google Scholar 

  24. O’Donnell TF. Medical problems of recruit training: a research approach. US Navy Med 1971; 58: 28–31

    Google Scholar 

  25. Magazanik A, Epstein Y, Udassin R, et al. Tap water, an efficient method for cooling heatstroke victims: a model in dogs. Aviat Space Environ Med 1980; 51(9): 864–6

    PubMed  CAS  Google Scholar 

  26. Proulx CI, Ducharme MB, Kenny GP. Effect of water temperature on cooling efficiency during hyperthermia in humans. J Appl Physiol 2003; 94(4): 1317–23

    PubMed  CAS  Google Scholar 

  27. Clements JM, Casa DJ, Knight J, et al. Ice-water immersion and cold-water immersion provide similar cooling rates in runners with exercise-induced hyperthermia. J Athl Train 2002; 37(2): 146–50

    PubMed  Google Scholar 

  28. McArdle WD, Magel JR, Lesmes GR, et al. Metabolic and cardiovascular adjustment to work in air and water at 18, 25, and 33 degrees C. J Appl Physiol 1976; 40(1): 85–90

    PubMed  CAS  Google Scholar 

  29. Barcroft H, Edholm OG. The effect of temperature on blood flow and deep temperature in the human forearm. J Physiol 1943; 102: 5–20

    PubMed  CAS  Google Scholar 

  30. Eichler AC, McFee AS, Root HD. Heat stroke. Am J Surg 1969; 118(6): 855–63

    Article  PubMed  CAS  Google Scholar 

  31. Jacobson S. The ill effects of heat. Emerg Med 1992; 24(7): 313–24

    Google Scholar 

  32. Francis KT. Exertional heat illness: a review. J Med Technol 1984; 1(7): 547–51

    Google Scholar 

  33. O’Donnell Jr TF, Clowes Jr GH. The circulatory abnormalities of heat stroke. N Engl J Med 1972; 287(15): 734–7

    Article  PubMed  Google Scholar 

  34. Travis SP. Management of heat stroke. J R Nav Med Serv 1988; 74(1): 39–43

    PubMed  CAS  Google Scholar 

  35. Khogali M. The Makkah body cooling unit. In: Khogali M, Hales JRS, editors. Heatstroke and temperature regulation. Sydney: Academic Press, 1983: 139–48

    Google Scholar 

  36. Khogali M, Weiner JS. Heat stroke: report on 18 cases. Lancet 1980; II(8189): 276–8

    Article  Google Scholar 

  37. Khogali M, Al-Khawashki MI. Heatstroke during the Makkah pilgrimmage. Saudi Med J 1981; 2: 85–93

    Google Scholar 

  38. Al-Aska AK, Abu-Aisha H, Yaqub B, et al. Simplified cooling bed for heatstroke [letter]. Lancet 1987; I(8529): 381

    Article  Google Scholar 

  39. Poulton TJ, Walker RA. Helicopter cooling of heatstroke victims. Aviat Space Environ Med 1987; 58(4): 358–61

    PubMed  CAS  Google Scholar 

  40. Hadad E, Moran DS, Epstein Y. Cooling heat stroke patients by available field measures. Intensive Care Med 2004 Feb; 30(2): 338. Epub 2003 Nov 29

    Article  PubMed  Google Scholar 

  41. Noakes TD. Heatstroke during the 1981 National Cross-Country Running Championships [letter]. S Afr Med J 1982; 61(5): 145

    PubMed  CAS  Google Scholar 

  42. Richards R, Richards D, Schofield PJ, et al. Management of heat exhaustion in Sydney’s the Sun City-to-Surf fun runners. Med J Aust 1979; 2(9): 457–61

    PubMed  CAS  Google Scholar 

  43. Richards R, Richards D. Exertion-induced heat exhaustion and other medical aspects of the City-to-Surf fun runs 1978–1984. Med J Aust 1984 Dec 8–22; 141(12–13): 799–805

    PubMed  CAS  Google Scholar 

  44. Kielblock AJ, Van Rensburg JP, Franz RM. Body cooling as a method for reducing hyperthermia: an evaluation of techniques. S Afr Med J 1986 Mar 15; 69(6): 378–80

    PubMed  CAS  Google Scholar 

  45. Bynum G, Patton J, Bowers W, et al. Peritoneal lavage cooling in an anesthetized dog heatstroke model. Aviat Space Environ Med 1978; 49(6): 779–84

    PubMed  CAS  Google Scholar 

  46. Horowitz BZ. The golden hour in heat stroke: use of iced peritoneal lavage. Am J Emerg Med 1989; 7(6): 616–9

    Article  PubMed  CAS  Google Scholar 

  47. White JD, Kamath R, Nucci R, et al. Evaporation versus iced peritoneal lavage treatment of heatstroke: comparative efficacy in a canine model. Am J Emerg Med 1993; 11(1): 1–3

    Article  PubMed  Google Scholar 

  48. Syverud SA, Barker WJ, Amsterdam JT, et al. Iced gastric lavage for treatment of heatstroke: efficacy in a canine model. Ann Emerg Med 1985; 14(5): 424–32

    Article  PubMed  CAS  Google Scholar 

  49. White JD, Riccobene E, Nucci R, et al. Evaporation versus iced gastric lavage treatment of heatstroke: comparative efficacy in a canine model. Crit Care Med 1987; 15(8): 748–50

    Article  PubMed  CAS  Google Scholar 

  50. Mack WJ, Huang J, Winfree C, et al. Ultrarapid, convection-enhanced intravascular hypothermia: a feasibility study in nonhuman primate stroke. Stroke 2003; 34(8): 1994–9

    Article  PubMed  Google Scholar 

  51. Schmutzhard E, Engelhardt K, Beer R, et al. Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study. Crit Care Med 2002; 30(11): 2481–8

    Article  PubMed  Google Scholar 

  52. Inderbitzen B, Yon S, Lasheras J, et al. Safety and performance of a novel intravascular catheter for induction and reversal of hypothermia in a porcine model. Neurosurgery 2002; 50(2): 364–70

    PubMed  Google Scholar 

  53. Ward A, Chaffman MO, Sorkin EM. Dantrolene: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic malignant syndrome and an update of its use in muscle spasticity. Drugs 1986; 32(2): 130–68

    Article  PubMed  CAS  Google Scholar 

  54. Lydiatt JS, Hill GE. Treatment of heat stroke with dantrolene [letter]. JAMA 1981; 246(1): 41–2

    Article  PubMed  CAS  Google Scholar 

  55. Denborough M. Severe heat stroke in an experienced athlete [letter]. Med J Aust 1982; 1: 204

    PubMed  CAS  Google Scholar 

  56. Amsterdam JT, Syverud SA, Barker WJ, et al. Dantrolene sodium for treatment of heat stroke victims: lack of efficacy in a canine model. Am J Emerg Med 1986; 4: 399–405

    Article  PubMed  CAS  Google Scholar 

  57. Channa AB, Seraj MA, Saddique AA, et al. Is dantrolene effective in heat stroke patients? Crit Care Med 1990; 18(3): 290–2

    Article  PubMed  CAS  Google Scholar 

  58. Bouchama A, Cafege A, Devol EB, et al. Ineffectiveness of dantrolene sodium in the treatment of heatstroke. Crit Care Med 1991; 19(2): 176–80

    Article  PubMed  CAS  Google Scholar 

  59. Moran D, Epstein Y, Wiener M, et al. Dantrolene and recovery from heat stroke. Aviat Space Environ Med 1999; 70(10): 987–9

    PubMed  CAS  Google Scholar 

  60. Zuckerman GB, Singer LP, Rubin DH, et al. Effects of dantrolene on cooling times and cardiovascular parameters in an immature porcine model of heatstroke. Crit Care Med 1997; 25(1): 135–9

    Article  PubMed  CAS  Google Scholar 

  61. Bouchama A, Parhar RS, el-Yazigi A, et al. Endotoxemia and release of tumor necrosis factor and interleukin 1 alpha in acute heatstroke. J Appl Physiol 1991; 70(6): 2640–4

    PubMed  CAS  Google Scholar 

  62. Bouchama A, al-Sedairy S, Siddiqui S, et al. Elevated pyrogenic cytokines in heatstroke. Chest 1993; 22: 553–61

    Google Scholar 

  63. Hammami MM, Bouchama A, Al-Sedairy S, et al. Concentrations of soluble tumor necrosis factor and interleukin-6 receptors in heatstroke and heat stress. Crit Care Med 1997; 25(8): 1314–9

    Article  PubMed  CAS  Google Scholar 

  64. Feldberg W, Gupta KP, Milton AS, et al. Effect of pyrogens and antipyretics on prostaglandin activity in cisternal c.s.f of unanaesthetized cats. J Physiol 1973; 234: 279–303

    PubMed  CAS  Google Scholar 

  65. Yarbrough BA, Hubbard RW. Heat related illness. In: Auerbach PS, Gelhr EC, editors. Management of wilderness and environmental emergencies. St Louis (MO): Mosby, 1989: 119–43

    Google Scholar 

  66. Henker R, Rogers S, Kramer DJ, et al. Comparison of fever treatments in the critically ill: a pilot study. Am J Crit Care 2001; 10(4): 276–80

    PubMed  CAS  Google Scholar 

  67. Moran DS, Gaffin SL. Clinical management of heat-related illnesses. In: Aurbach PS, editor. Wilderness medicine. St Louis (MO): Mosby, 2001: 290–316

    Google Scholar 

  68. Armstrong LE, Epstein Y, Greenleaf JE, et al. American College of Sports Medicine position stand: heat and cold illnesses during distance running. Med Sci Sports Exerc 1996; 28(12): i–x

    CAS  Google Scholar 

  69. Binkley HM, Beckett J, Casa DJ, et al. National Athletic Trainers’ Association position statement: exertional heat illnesses. J Athl Train 2002; 37(3): 329–43

    PubMed  Google Scholar 

  70. Khogali M, El-Sayed H, Amar M, et al. Management and therapy regimen during cooling and in the recovery room at different heatstroke treatment centers. In: Khogali M, Hales JRS, editors. Heatstroke and temperature regulation. New York: Academic Press, 1983: 149–56

    Google Scholar 

  71. Tucker LE, Stanford J, Graves B, et al. Classical heatstroke: clinical and laboratory assessment. South Med J 1985; 78(1): 20–5

    Article  PubMed  CAS  Google Scholar 

  72. Tipton MJ, Allsopp AJ, Balmi PJ, et al. Hand immersion as a method of cooling and rewarming. J R Nav Med Serv 1993; 79: 125–31

    PubMed  CAS  Google Scholar 

  73. Neill WA, Duncan DA, Kloster F, et al. Response of coronary circulation to cutaneous cold. Am J Med 1974; 56: 471–6

    Article  PubMed  CAS  Google Scholar 

  74. Roberts WO. Managing heatstroke: on site cooling. Phys Sportsmed 1992; 20(5): 17–9

    Google Scholar 

  75. Management of heatstroke. Lancet 1982; II(8304): 910–1

    Google Scholar 

  76. Clapp AJ, Bishop PA, Muir I, et al. Rapid cooling techniques in joggers experiencing heat strain. J Sci Med Sport 2001; 4(2): 160–7

    Article  PubMed  CAS  Google Scholar 

  77. Mitchell JB, Schiller ER, Miller JR, et al. The influence of different external cooling methods on thermoregulatory responses before and after intense intermittent exercise in the heat. J Strength Cond Res 2001; 15(2): 247–54

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Sheba Medical Center, Heller Institute of Medical Research, Tel Hashomer, 52621, Israel

    Eran Hadad, Moshe Rav-Acha, Yuval Heled,  Yoram Epstein & Daniel S. Moran

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Eran Hadad, Moshe Rav-Acha, Yuval Heled &  Yoram Epstein

Authors
  1. Eran Hadad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moshe Rav-Acha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuval Heled
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoram Epstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel S. Moran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoram Epstein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hadad, E., Rav-Acha, M., Heled, Y. et al. Heat Stroke. Sports Med 34, 501–511 (2004). https://doi.org/10.2165/00007256-200434080-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-200434080-00002

Keywords

Search

Navigation