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Comp G, Pugsley P, Sklar D, Akhter M, McElhinny M, Erickson E, Feinstein B, Enenbach M, Williams L, Pearlmutter J, Stowell JR. Heat Stroke Management Updates: A Description of the Development of a Novel in-Emergency Department Cold-Water Immersion Protocol and Guide for Implementation. Ann Emerg Med 2024:S0196-0644(24)00407-4. [PMID: 39320280 DOI: 10.1016/j.annemergmed.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 09/26/2024]
Abstract
The growing prevalence of heat stroke as a public health issue, exacerbated by climate change and increasing global temperatures, demands an immediate and strategic response to prevent weather-related morbidity and mortality. Heat stroke results from the body's inability to cope with excessive heat, leading to systemic inflammatory responses, cellular apoptosis, and potential multiorgan dysfunction or failure. However, little information explicitly outlines how to perform cold-water immersion in the emergency department (ED), including potential patient selection, how much water or ice to use, target temperatures, when to stop, and complications or challenges with the process. This narrative explores implementing a comprehensive protocol for total-body cold-water immersion developed in an ED setting, a method proven effective in rapidly reducing core body temperatures, with the goal of reducing mortality and morbidity rates associated with heat-related illnesses. The protocol involves immediate temperature assessment, followed by cold-water immersion for patients with altered mental status and core temperatures above 40 °C. Discussion about the development of the process and results from applying the protocol during the summer of 2023, including cooling rates and patient outcomes, is also included. Additionally, the article addresses challenges and lessons learned during the protocol's implementation, emphasizing the importance of multidisciplinary collaboration, staff education, and the adaptation of ED infrastructure to support this lifesaving treatment based on its use during the last 3 years. The successful resolution of the presented cases, along with the protocol's potential for widespread adoption, illustrates the critical role of cold-water immersion in enhancing ED responses to heat stroke, offering a blueprint for future research and the development of similar protocols across health care settings. This work contributes to the evolving landscape of emergency medicine and aligns with the global effort to combat the adverse health effects of climate change.
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Affiliation(s)
- Geoffrey Comp
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ.
| | - Paul Pugsley
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ
| | - David Sklar
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ; Arizona State University, College of Health Solutions, Phoenix, AZ
| | - Murtaza Akhter
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ; Penn State Health Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, PA; Kendall Regional Medical Center, HCA Healthcare, Department of Emergency Medicine, Miami, FL
| | - Megan McElhinny
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ
| | - Ethan Erickson
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ
| | - Bryan Feinstein
- Tucson Medical Center, Tucson, AZ; Grand Canyon National Park Emergency Services, Grand Canyon Village, AZ
| | - Molly Enenbach
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ
| | - Lindsay Williams
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ
| | - Jacquelyn Pearlmutter
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ
| | - Jeffrey R Stowell
- Valleywise Health Medical Center, Department of Emergency Medicine, Phoenix, AZ; Creighton University School of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, AZ
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Tabisz H, Modlinska A, Kujawski S, Słomko J, Zalewski P. Whole-body cryotherapy as a treatment for chronic medical conditions? Br Med Bull 2023; 146:43-72. [PMID: 37170956 DOI: 10.1093/bmb/ldad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Whole-body cryotherapy (WBC) is a controlled exposure of the whole body to cold to gain health benefits. In recent years, data on potential applications of WBC in multiple clinical settings have emerged. SOURCES OF DATA PubMed, EBSCO and Clinical Key search using keywords including terms 'whole body', 'cryotherapy' and 'cryostimulation'. AREAS OF AGREEMENT WBC could be applied as adjuvant therapy in multiple conditions involving chronic inflammation because of its potent anti-inflammatory effects. Those might include systemic inflammation as in rheumatoid arthritis. In addition, WBC could serve as adjuvant therapy for chronic inflammation in some patients with obesity. AREAS OF CONTROVERSY WBC probably might be applied as an adjuvant treatment in patients with chronic brain disorders including mild cognitive impairment and general anxiety disorder and in patients with depressive episodes and neuroinflammation reduction as in multiple sclerosis. WBC effects in metabolic disorder treatment are yet to be determined. WBC presumably exerts pleiotropic effects and therefore might serve as adjuvant therapy in multi-systemic disorders, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). GROWING POINTS The quality of studies on the effects of WBC in the clinical setting is in general low; hence, randomized controlled trials with adequate sample size and longer follow-up periods are needed. AREAS ARE TIMELY FOR DEVELOPING RESEARCH Further studies should examine the mechanism underlying the clinical efficacy of WBC. Multiple conditions might involve chronic inflammation, which in turn could be a potential target of WBC. Further research on the application of WBC in neurodegenerative disorders, neuropsychiatric disorders and ME/CFS should be conducted.
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Affiliation(s)
- Hanna Tabisz
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
| | - Aleksandra Modlinska
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
| | - Sławomir Kujawski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
| | - Joanna Słomko
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
| | - Pawel Zalewski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Warsaw Medical University, 1b Banacha Street, Warsaw 02-097, Poland
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Brearley M, Berry R, Hunt AP, Pope R. A Systematic Review of Post-Work Core Temperature Cooling Rates Conferred by Passive Rest. BIOLOGY 2023; 12:biology12050695. [PMID: 37237510 DOI: 10.3390/biology12050695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Physical work increases energy expenditure, requiring a considerable elevation of metabolic rate, which causes body heat production that can cause heat stress, heat strain, and hyperthermia in the absence of adequate cooling. Given that passive rest is often used for cooling, a systematic search of literature databases was conducted to identify studies that reported post-work core temperature cooling rates conferred by passive rest, across a range of environmental conditions. Data regarding cooling rates and environmental conditions were extracted, and the validity of key measures was assessed for each study. Forty-four eligible studies were included, providing 50 datasets. Eight datasets indicated a stable or rising core temperature in participants (range 0.000 to +0.028 °C min-1), and forty-two datasets reported reducing core temperature (-0.002 to -0.070 °C min-1) during passive rest, across a range of Wet-Bulb Globe Temperatures (WBGT). For 13 datasets where occupational or similarly insulative clothing was worn, passive rest resulted in a mean core temperature decrease of -0.004 °C min-1 (-0.032 to +0.013 °C min-1). These findings indicate passive rest does not reverse the elevated core temperatures of heat-exposed workers in a timely manner. Climate projections of higher WBGT are anticipated to further marginalise the passive rest cooling rates of heat-exposed workers, particularly when undertaken in occupational attire.
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Affiliation(s)
- Matt Brearley
- Thermal Hyperformance, Hervey Bay, QLD 4655, Australia
- National Critical Care and Trauma Response Centre, Darwin, NT 0800, Australia
- School of Allied Health, Exercise & Sports Sciences, Charles Sturt University, Albury, NSW 2640, Australia
| | - Rachel Berry
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Andrew P Hunt
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia
| | - Rodney Pope
- School of Allied Health, Exercise & Sports Sciences, Charles Sturt University, Albury, NSW 2640, Australia
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
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Comparison of 4 Different Cooldown Strategies on Lower-Leg Temperature, Blood Lactate Concentration, and Fatigue Perception After Intense Running. J Sport Rehabil 2022; 31:1052-1060. [PMID: 35894914 DOI: 10.1123/jsr.2021-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/18/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT Although active recovery (AR) and cold application is recommended, many people take a shower after exercise. Therefore, a direct comparison between a shower and other recommended methods (AR and/or cold-water immersion) is necessary. To compare immediate effects of 4 postexercise cooldown strategies after running. DESIGN A crossover design. METHODS Seventeen young, healthy males (23 y; 174 cm; 73 kg) visited on 4 different days and performed a 10-minute intense treadmill run (5 km/h at a 1% incline, then a belt speed of 1 km/h, and an incline of 0.5% were increased every minute). Then, subjects randomly experienced 4 different 30-minute cooldown strategies each session-AR (10-min treadmill walk + 10-min static stretch + 10-min shower), cold-water walk (10-min shower + 20-min walk in cold water), cold-water sit (10-min shower + 20-min sit in cold water), and passive recovery (10-min shower + 20-min passive recovery). Across the cooldown conditions, the water temperatures for immersion and shower were set as 18 °C and 25 °C, respectively. Lower-leg muscle temperature, blood lactate concentration, and fatigue perception were statistically compared (P < .001 for all tests) and effect sizes (ES) were calculated. RESULTS The cold-water walk condition (F135,2928 = 69.29, P < .0001) was the most effective in reducing muscle temperature after running (-11.6 °C, ES = 9.46, P < .0001), followed by the cold-water sit (-8.4 °C, ES = 8.61, P < .0001), passive recovery (-4.5 °C, ES = 4.36, P < .0001), and AR (-4.0 °C, ES = 4.29, P < .0001) conditions. Blood lactate concentration (F6,176 = 0.86, P = .52) and fatigue perception (F6,176 = 0.18, P = .98) did not differ among the 4 conditions. CONCLUSIONS While the effect of lowering the lower-leg temperature was different, the effect of reducing blood lactate concentration and fatigue perception were similar in the 4 cooldown strategies. We suggest selecting the appropriate method while considering the specific goal, available time, facility, and accessibility.
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Klous L, van Diemen F, Ruijs S, Gerrett N, Daanen H, de Weerd M, Veenstra B, Levels K. Efficiency of three cooling methods for hyperthermic military personnel linked to water availability. APPLIED ERGONOMICS 2022; 102:103700. [PMID: 35231652 DOI: 10.1016/j.apergo.2022.103700] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Three feasible cooling methods for treatment of hyperthermic individuals in the military, that differed considerably in water volume needed (none to ~80 L), were evaluated. METHODS Ten male soldiers were cooled following exercise-induced hyperthermia (rectal temperature (Tre) ∼39.5 °C) using ventilation by fanning (1.7 m s-1), ventilation by fanning (1.7 m s-1) while wearing a wet t-shirt (250 mL-27 °C water) and tarp assisted cooling with oscillations (80 L of 27.2 ± 0.5 °C water; TACO). RESULTS Cooling rates were higher using TACO (0.116 ± 0.032 °C min-1) compared to ventilation (0.065 ± 0.011 °C min-1, P<0.001) and ventilation in combination with a wet t-shirt (0.074 ± 0.020 °C min-1, P=0.002). Time to cool (TTC) to Tre=38.2 °C for TACO was shorter (14 ± 4 min) compared to ventilation only (20 ± 5 min; P=0.018), but not to ventilation while wearing a wet t-shirt (18 ± 6 min; P=0.090). CONCLUSIONS TACO may be an acceptable, efficient and feasible cooling method in case of exertional heat stroke. However, in case of limited water availability, transportat should be prioritized, and cooling of any form should be implemented while waiting for and during transport.
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Affiliation(s)
- Lisa Klous
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Netherlands Organization for Applied Scientific Research (TNO), Department of Human Performance, Unit Defence, Safety and Security, Soesterberg, The Netherlands
| | - Femke van Diemen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Silke Ruijs
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Nicola Gerrett
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Gentherm Inc., Michigan, USA
| | - Hein Daanen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marijne de Weerd
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands
| | - Bertil Veenstra
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands
| | - Koen Levels
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands.
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Kanda J, Nakahara S, Nakamura S, Miyake Y, Shimizu K, Yokobori S, Yaguchi A, Sakamoto T. Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion. PLoS One 2021; 16:e0259441. [PMID: 34788312 PMCID: PMC8598059 DOI: 10.1371/journal.pone.0259441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the "severe" group or the "mild-to-moderate" group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received "active cooling + rehydration" and patients who received "rehydration only," with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21-8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92-5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.
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Affiliation(s)
- Jun Kanda
- Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinji Nakahara
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
| | | | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shoji Yokobori
- Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Arino Yaguchi
- Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan
- Department of Critical Care and Emergency Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Hayashi K. A novel cooling method using carbon dioxide-rich water after passive heating. J Therm Biol 2021; 96:102843. [PMID: 33627279 DOI: 10.1016/j.jtherbio.2021.102843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
In the event of a marked rise in body temperature, it is often necessary to reduce the temperature quickly. One method to rapidly drop body temperature is cold water immersion. Because carbon dioxide (CO2)-rich water causes cutaneous vasodilation, it may be that CO2-rich water reduces body temperature faster than fresh water. To test that idea, I compared the effects of CO2-rich and tap water immersion on auditory canal temperature (Tac) after passive heating. Nine healthy male subjects participated in the study. Subjects were first immersed for 15 min in a tap water bath at 40 °C to raise body temperature. They then moved to a tap water or CO2-rich water bath at 30 °C to reduce body temperature. Immersion in 40 °C tap water caused Tac to rise 0.64 ± 0.11 °C in the tap water session and 0.71 ± 0.25 °C in the CO2-rich water session (P > 0.05). During the 30 °C water immersion, Tac declined and was significantly lower in CO2-rich water than in tap water. Cooling rates were 0.06 ± 0.04 °C/min in tap water and 0.11 ± 0.05 °C/min in CO2-rich water (P < 0.05). In addition, both thermal sensation (3.2 ± 1.0 vs. 2.1 ± 0.9; P < 0.01) and thermal comfort (1.2 ± 0.4 vs. 2.1 ± 0.8; P < 0.01) were significantly better in CO2-rich water than tap water. These results suggest that CO2-rich water immersion reduces Tac 1.7 times faster than tap water immersion, and that CO2-rich water immersion cools the body more comfortably than tap water immersion.
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Affiliation(s)
- Keiji Hayashi
- Junior College, University of Shizuoka, 2-2-1 Oshika, Suruga-ku, Shizuoka, 422-8021, Japan.
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Singletary EM, Zideman DA, Bendall JC, Berry DA, Borra V, Carlson JN, Cassan P, Chang WT, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin A, Sakamoto T, Swain JM, Woodin JA, De Buck E, De Brier N, O D, Picard C, Goolsby C, Oliver E, Klaassen B, Poole K, Aves T, Lin S, Handley AJ, Jensen J, Allan KS, Lee CC. 2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation 2020; 156:A240-A282. [PMID: 33098920 DOI: 10.1016/j.resuscitation.2020.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.
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Singletary EM, Zideman DA, Bendall JC, Berry DC, Borra V, Carlson JN, Cassan P, Chang WT, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin AM, Sakamoto T, Swain JM, Woodin JA. 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation 2020; 142:S284-S334. [PMID: 33084394 DOI: 10.1161/cir.0000000000000897] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.
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Do Alternative Cooling Methods Have Effective Cooling Rates for Hyperthermia Compared With Previously Established CWI Cooling Rates? J Sport Rehabil 2020; 29:367-372. [PMID: 31628268 DOI: 10.1123/jsr.2019-0098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/04/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: In the last few years, there have been several studies examining alternative cooling strategies in the treatment of exertional heat stroke (EHS). Morbidity and mortality with EHS are associated with how long the patient's core body temperature remains above the critical threshold of 40.5°C. Although cold-water immersion (CWI) is the gold standard of treatment when cooling a patient with EHS, more recent alternative cooling techniques have been examined for use in settings where CWI may not be feasible (ie, remote locations). Clinical Question: Do alternative cooling methods have effective core body temperature cooling rates for hyperthermia compared with previously established CWI cooling rates? Summary of Key Findings: The authors searched for studies using alternative cooling methods to cool hyperthermic individuals. To be included, the studies needed a PEDro score ≥6 and a level of evidence ≥2. They found 9 studies related to our focused clinical question; of these, 5 studies met the inclusion criteria. The cooling rates for hand cooling, cold-water shower, and ice-sheet cooling were 0.03°C/min, 0.08°C/min, and 0.06°C/min, respectively, whereas the tarp-assisted cooling with oscillation (TACO) method was the only method that had an acceptable cooling rate (range 0.14-0.17°C/min). Clinical Bottom Line: When treating EHS, if CWI is not available, the tarp-assisted cooling method may be a reasonable alternative. Clinicians should not use cold shower, hand cooling, or ice-sheet cooling if better cooling methods are available. Clinicians should always use CWI when available. Strength of Recommendation: Five level 2 studies with PEDro scores ≥6 suggest the TACO method is the only alternative cooling method that decreases core body temperature at a similar, though slower, rate of CWI. Hand cooling, cold showering, and ice-sheet cooling do not decrease core body temperature at an appropriate rate and should not be used in EHS situations if a modality with a better cooling rate is available.
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First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Resuscitation 2020; 148:173-190. [PMID: 31981710 DOI: 10.1016/j.resuscitation.2020.01.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/02/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Heat stroke is an emergent condition characterized by hyperthermia (>40 °C/>104 °F) and nervous system dysregulation. There are two primary etiologies: exertional which occurs during physical activity and non-exertional which occurs during extreme heat events without physical exertion. Left untreated, both may lead to significant morbidity, are considered a special circumstance for cardiac arrest, and cause of mortality. METHODS We searched Medline, Embase, CINAHL and SPORTDiscus. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods and risk of bias assessments to determine the certainty and quality of evidence. We included randomized controlled trials, non-randomized trials, cohort studies and case series of five or more patients that evaluated adults and children with non-exertional or exertional heat stroke or exertional hyperthermia, and any cooling technique applicable to first aid and prehospital settings. Outcomes included: cooling rate, mortality, neurological dysfunction, adverse effects and hospital length of stay. RESULTS We included 63 studies, of which 37 were controlled studies, two were cohort studies and 24 were case series of heat stroke patients. Water immersion of adults with exertional hyperthermia [cold water (14-17 °C/57.2-62.6 °F), colder water (8-12 °C/48.2-53.6 °F) and ice water (1-5 °C/33.8-41 °F)] resulted in faster cooling rates when compared to passive cooling. No single water temperature range was found to be associated with a quicker core temperature reduction than another (cold, colder or ice). CONCLUSION Water immersion techniques (using 1-17 °C water) more effectively lowered core body temperatures when compared with passive cooling, in hyperthermic adults. The available evidence suggests water immersion can rapidly reduce core body temperature in settings where it is feasible.
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Heatstroke management during the COVID-19 epidemic: recommendations from the experts in Japan. Acute Med Surg 2020; 7:e560. [PMID: 32837733 PMCID: PMC7436206 DOI: 10.1002/ams2.560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023] Open
Abstract
Fever and hyperthermia are the main symptoms of coronavirus disease (COVID-19) and heatstroke, and it is difficult to distinguish them. There is a need to discuss safe prevention and medical treatment for heatstroke. In view of the above issues, the Japanese Association for Acute Medicine "Committee on heatstroke and hypothermia" established a "Working group on heatstroke medical care given the COVID-19 epidemic" jointly with the Japanese Society for Emergency Medicine that focuses on emergency medical personnel, including paramedics and nurses, the Japanese Association for Infectious Diseases, an academic society of infectious disease, and the Japanese Respiratory Society, an academic organization on respiratory diseases. The precautions for prevention of heatstroke this summer during the coronavirus epidemic was summarized in "Proposals on heatstroke prevention based on the COVID-19 epidemic" as follows and was issued on 1 June, 2020. Based on the above, we have determined that guidance in clinical practice is necessary not only from the viewpoint of heatstroke prevention, but also medical treatment. As such, we have created this guidance in the form of supplementary recommendations.
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Leyk D, Hoitz J, Becker C, Jochen Glitz K, Nestler K, Piekarski C. Health Risks and Interventions in Exertional Heat Stress. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:537-544. [PMID: 31554541 PMCID: PMC6783627 DOI: 10.3238/arztebl.2019.0537] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND With climate change, heat waves are expected to become more frequent in the near future. Already, on average more than 25 000 "heat deaths" are estimated to occur in Europe every year. However, heat stress and heat illnesses arise not just when ambient temperatures are high. Physical exertion increases heat production within the organism many times over; if not enough heat is lost, there is a risk of exertional heat stress. This review article discusses contributing factors, at-risk groups, and the diagnosis and treatment of heat illnesses. METHODS A selective literature search was carried out on PubMed. Current guidelines and expert recommendations were also included. RESULTS Apart from muscular heat production (>70% of converted energy), there are other factors that singly or in combination can give rise to heat stress: clothing, climate/acclimatization, and individual factors. Through its insulating properties, clothing reduces the evaporation of sweat (the most effective physiological cooling mechanism). A sudden heat wave, or changing the climate zone (as with air travel), increases the risk of a heat-related health event. Overweight, low fitness level, acute infections, illness, dehydration, and other factors also reduce heat tolerance. In addition to children, older people are particularly at risk because of their reduced physiological adaptability, (multi-)morbidity, and intake of prescription drugs. A heat illness can progress suddenly to life-threatening heat stroke. Successful treatment depends on rapid diagnosis and cooling the body down as quickly as possible. The aim is to reduce core body temperature to <40 °C within 30 minutes. CONCLUSION Immediately effective cooling interventions are the only causal treatment for heat stroke. Time once lost cannot be made up. Prevention (acclimatization, reduced exposure, etc.) and terminating the heat stress in good time (e.g., stopping work) are better than any cure.
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Affiliation(s)
- Dieter Leyk
- Bundeswehr Institute for Preventive Medicine
- German Sport University Cologne
| | | | - Clemens Becker
- Department of Geriatrics and Geriatric Rehabilitation at the Robert-Bosch-Hospital Stuttgart
| | | | | | - Claus Piekarski
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne
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Ajjimaporn A, Chaunchaiyakul R, Pitsamai S, Widjaja W. Effect of Cold Shower on Recovery From High-Intensity Cycling in the Heat. J Strength Cond Res 2019; 33:2233-2240. [PMID: 31343603 DOI: 10.1519/jsc.0000000000003017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ajjimaporn, A, Chaunchaiyakul, R, Pitsamai, S, and Widjaja, W. Effect of cold shower on recovery from high-intensity cycling in the heat. J Strength Cond Res 33(8): 2233-2240, 2019-Post-exercise cooling, e.g., cold water immersion has shown beneficial cardiovascular and hormonal effects during recovery from exercise in a hot environment. However, not much is known about the effects of a cold water shower (CWS) as a recovery intervention. This study examined the effects of a CWS on heart rate (HR), core temperature (Tc), salivary cortisol, and thermal comfort sensation (TCS) after exercise in the heat. Nine healthy male subjects (age, 21 ± 1 year) performed 45 minutes of cycling in a hot environment (35° C, 40-60% relative humidity) at 65% of peak oxygen uptake. Thereafter, subjects underwent the CWS condition (15 minutes, 15° C water shower) or control (SIT25; 15 minutes passive recovery in 25° C room) in a randomized crossover design. After each 15 minutes, subjects sat in a 25° C room for another 2-hour recovery. Heart rate, Tc, and TCS were recorded before and immediately after exercise, immediately after CWS or SIT25, and at 30 minutes, 1, and 2 hours during additional recovery. Salivary cortisol was collected at the same time points except at 30 minutes of the additional recovery period. Thermal comfort sensation was higher immediately after CWS (+4; very comfortable) than SIT25 (+1; just comfortable). The change of HR decreased faster with CWS (-18.3 ± 2.3%) than with SIT25 (-7.0 ± 4.6%) at the first 30-minute recovery time point (p < 0.01). No differences between recovery conditions were observed for the Tc or salivary cortisol at any time point during the 2-hour recovery period. The findings demonstrate that a 15-minute, 15° C CWS was not effective in reducing Tc or salivary cortisol during recovery from exercise in a hot environment. However, CWS can promote TCS by facilitating a faster HR recovery after 30-minute postintervention compared with passive recovery. The cooling benefits of a CWS could be only recommended to reduce cardiac stress after routine workout in a hot environment.
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Affiliation(s)
- Amornpan Ajjimaporn
- Department of Sports Physiology, College of Sports Science and Technology, Mahidol University, Salaya, Nakhonpathom, Thailand
| | - Rungchai Chaunchaiyakul
- Department of Sports Physiology, College of Sports Science and Technology, Mahidol University, Salaya, Nakhonpathom, Thailand
| | - Sirikun Pitsamai
- Faculty of Sports and Health Science, Institute of Physical Education Phetchabun, Muang District, Phetchabun, Thailand
| | - Waree Widjaja
- Department of Sports Physiology, College of Sports Science and Technology, Mahidol University, Salaya, Nakhonpathom, Thailand
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Belval LN, Casa DJ, Adams WM, Chiampas GT, Holschen JC, Hosokawa Y, Jardine J, Kane SF, Labotz M, Lemieux RS, McClaine KB, Nye NS, O'Connor FG, Prine B, Raukar NP, Smith MS, Stearns RL. Consensus Statement- Prehospital Care of Exertional Heat Stroke. PREHOSP EMERG CARE 2018; 22:392-397. [PMID: 29336710 DOI: 10.1080/10903127.2017.1392666] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Exertional heat stroke (EHS) is one of the most common causes of sudden death in athletes. It also represents a unique medical challenge to the prehospital healthcare provider due to the time sensitive nature of treatment. In cases of EHS, when cooling is delayed, there is a significant increase in organ damage, morbidity, and mortality after 30 minutes, faster than the average EMS transport and ED evaluation window. The purpose of this document is to present a paradigm for prehospital healthcare systems to minimize the risk of morbidity and mortality for EHS patients. With proper planning, EHS can be managed successfully by the prehospital healthcare provider.
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Debnath T, Bera S, Deb S, Pal P, Debbarma N, Haldar A. Application of radio frequency based digital thermometer for real-time monitoring of dairy cattle rectal temperature. Vet World 2017; 10:1052-1056. [PMID: 29062193 PMCID: PMC5639102 DOI: 10.14202/vetworld.2017.1052-1056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/11/2017] [Indexed: 01/02/2023] Open
Abstract
Aim: Dairy cattle health monitoring program becomes vital for detecting the febrile conditions to prevent the outbreak of the animal diseases as well as ensuring the fitness of the animals that are directly affecting the health of the consumers. The aim of this study was to validate real-time rectal temperature (RT) data of radio frequency based digital (RFD) thermometer with RT data of mercury bulb (MB) thermometer in dairy cattle. Materials and Methods: Two experiments were conducted. In experiment I, six female Jersey crossbred cattle with a mean (±standard error of the mean) body weight of 534.83±13.90 kg at the age of 12±0.52 years were used to record RT for 2 h on empty stomach and 2 h after feeding at 0, 30, 60, 90, and 120 min using a RFD thermometer as well as a MB thermometer. In experiment II, six female Jersey crossbred cattle were further used to record RT for 2 h before exercise and 2 h after exercise at 0, 30, 60, 90, and 120 min. Two-way repeated measures analysis of variance with post hoc comparisons by Bonferroni test was done. Results: Real-time RT data recorded by RFD thermometer as well as MB thermometer did not differ (p>0.05) before and after feeding/exercise. An increase (p<0.05) in RT after feeding/exercise in experimental crossbred cattle was recorded by both RFD thermometer and MB thermometer. Conclusion: The results obtained in the present study suggest that the body temperature recordings from RFD thermometer would be acceptable and thus RFD thermometer could work well for monitoring real-time RT in cattle.
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Affiliation(s)
- Tridib Debnath
- ICAR Research Complex for North Eastern Hill Region, Tripura Centre, Agartala, Lembucherra - 799 210, Tripura, India.,Department of Livestock Production Management, West Bengal University of Animal and Fishery Sciences, Kolkata - 700 037, West Bengal, India
| | - Santanu Bera
- Department of Livestock Production Management, West Bengal University of Animal and Fishery Sciences, Kolkata - 700 037, West Bengal, India
| | - Suman Deb
- Department of Computer Science and Engineering, National Institute of Technology, Agartala, Tripura, India
| | - Prasenjit Pal
- Department of Extension and Social Sciences, College of Fisheries, Central Agricultural University, Lembucherra - 799 210, Tripura, India
| | - Nibash Debbarma
- ICAR Research Complex for North Eastern Hill Region, Tripura Centre, Agartala, Lembucherra - 799 210, Tripura, India
| | - Avijit Haldar
- ICAR Research Complex for North Eastern Hill Region, Tripura Centre, Agartala, Lembucherra - 799 210, Tripura, India
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Real-time monitoring of peripheral body temperature using non-invasive, self-powered, sensor based radio-frequency device in goats (capra hircus). Small Rumin Res 2016. [DOI: 10.1016/j.smallrumres.2016.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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