management

Last edited 08/2022 and last reviewed 08/2022

Heat stroke progresses to multiorgan dysfunction syndrome; therefore, rapid, effective cooling followed by close monitoring and specific treatment for injured organs are fundamental to treatment success (1,2)

• intubation for profound unconsciousness is rarely needed, as rapid cooling quickly improves the Glasgow coma scale (3)
• adequate rehydration is essential without over-correcting the sodium if derangements exist
• is mandatory to measure core temperature with a rectal or esophageal probe continually and cooling measures should be stopped once the temperature is 38 to 39 degrees Celsius
  • is no evidence to support a specific temperature end point; however, a rectal temperature of 39.4 °C has been used in large series and has been proven to be safe (1)
• several cooling methods are available in the clinical settings, including immersion, evaporation, and the use of cold water bladders, gastric and rectal lavage, and noninvasive cooling systems
  • however, there is no evidence supporting the superiority of any one cooling method for patients with heat stroke (1,3)
• ice bath immersion is the timeliest to reduce core body temperature, however, in older populations, it may not be realistic as cardiac monitoring may not be feasible and extreme agitation may hinder compliance (3)
  • other common methods include ice pack applications to the groin or axilla and evaporative cooling using a fan with cool saline on the skin of patients
• extracorporeal circulation with hemodiafiltration circuits for cooling patients with severe heat stroke has been used and has reported improved cooling efficiency (1)

Pharmacologic adjuncts may be required:

• dantrolene is a skeletal muscle relaxer, shown to reduce heat production in sustained muscle contracture, and is useful for the treatment of malignant hyperthermia
  • however, it has been shown to have no effect on patient outcomes with heat stroke (3)
• use of benzodiazepines could be considered for the shivering, agitated patient
• is no role for antipyretics in the treatment of heatstroke patients and may be toxic to the liver (3)

Reference:

• Hifumi T, Kondo Y, Shimizu K, Miyake Y. Heat stroke. J Intensive Care. 2018;6:30. Published 2018 May 22. doi:10.1186/s40560-018-0298-4
• Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002 Jun 20;346(25):1978-88. doi: 10.1056/NEJMra011089. PMID: 12075060.
• Morris A, Patel G. Heat Stroke. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2021. PMID: 30725820.