Heatstroke
ICD-10 T67.0 · ICD-11 NF01.0

Heatstroke: What to Do When Initial Active Cooling Did Not Reach the Temperature Target

Clinical situation

A patient with heatstroke was treated with first-line active cooling but did not achieve adequate temperature reduction within the required window. The question is what to do next.

Previous line — what did not work

Active cooling with ice-water immersion or cold-water immersion was used as the initial approach. This line is considered to have failed when a core body temperature below 39°C was not reached within 30 minutes from symptom recognition, or when the cooling rate fell below 0.155°C/min.

Next step — partial overview

When the initial cooling method cannot be used or proved insufficient, an alternative active cooling method — or a carefully selected combination of methods — is applied with the aim of achieving a rapid rate of temperature reduction. The specific options and how to select among them are laid out in the full protocol.

Treatment goal Reach a core body temperature below 39°C within 30 minutes from recognition of heatstroke symptoms.
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1097/CCM.0000000000006551

In situations where this cannot be done, clinicians should choose a method or combination of methods that will achieve a rapid rate of temperature reduction and reach the target temperature within 30 minutes of onset of heat stroke symptoms, considering the patient's initial core body temperature, if available.

Secondary alternatives are highlighted in Figure 1.

Clinicians are advised to select the method or combination of methods that will achieve the fastest rate of temperature reduction.

Clinicians should choose cooling methods that reach the target temperature within 30 minutes from recognition of heat stroke symptoms.

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