Should Cooling Vests Be Used to Treat Exertional Heatstroke? A Critically Appraised Topic

Clinical Scenario: Exercise performed in hot and humid environments increases core body temperature (T_C). If T_C exceeds 40.5°C for prolonged periods of time, exertional heat stroke (EHS) may occur. EHS is a leading cause of sudden death in athletes. Mortality and morbidity increase the longer the patient's T_C remains above 40.5°C; thus, it is imperative to initiate cooling as quickly as possible. Acceptable cooling rates in EHS situations are 0.08-0.15°C/min, while ideal cooling rates are above 0.16°C/min. Cooling vests are popular alternatives for cooling hyperthermic adults. Most vests cover the anterior and posterior torso and have varying numbers of pouches for phase-change materials (eg, gel packs); some vests only use circulating water to cool. While cooling vests offer several advantages (eg, portability), studies demonstrating their effectiveness at rapidly reducing T_C in EHS scenarios are limited.

Are T_C cooling rates acceptable (ie, >0.08°C/min) when hyperthermic humans are treated with cooling vests postexercise?

No significant differences in T_C cooling rates occurred between cooling vests and no cooling vests. Cooling rates across all studies were ≤0.053°C/min. Clinical Bottom Line: Cooling vests do not provide acceptable cooling rates of hyperthermic humans postexercise and should not be used to treat EHS. Instead, EHS patients should be treated with cold-water immersion within 30 min of collapse to avoid central nervous system dysfunction and organ failure. Strength of Recommendation: Strong evidence (eg, level 2 studies with PEDro scores ≥5) suggests that cooling vests do not reduce T_C quickly and thus should not be used in EHS scenarios.