First-Line Treatment of Heatstroke: Active Cooling Protocol
Heatstroke is a time-critical emergency. Rapid reduction of core body temperature is the defining first-line intervention, and the method used to achieve cooling determines how quickly the target is reached.
Treatment Approach
First-line management is built around active cooling — a class of interventions shown to outperform passive approaches. Within active cooling, immersion-based techniques are specifically prioritised due to their superior capacity for rapid temperature reduction.
The complete protocol — including method selection, clinical decision criteria, and full management algorithm — is available in the structured regimen below.
Clinical Targets
- Core body temperature below 39°C
- Target temperature reached within 30 minutes of recognition
- Cooling rate of at least 0.155°C/min
References
DOI: 10.1097/CCM.0000000000006551
- We recommend active cooling methods over passive cooling in patients with heat stroke (strong recommendation, very low certainty of evidence).
- Clinicians should prioritize cooling methods that achieve the most rapid rate of cooling, which is ice-water immersion (1–5°C) or cold-water immersion (9–12°C).
- Cold-water immersion or ice-water immersion will result in the fastest rate of temperature reduction and shortest time to target temperature (<39°C).
- Clinicians should choose cooling methods that reach the target temperature within 30 minutes from recognition of heat stroke symptoms.
- Clinicians should prioritize cooling modalities that achieve a cooling rate greater than or equal to 0.155°C/min.
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