What every intensivist should know about exertional heat stroke

Area of Science:

• Emergency Medicine
• Sports Medicine
• Environmental Health

Background:

• Exertional heat stroke (EHS) is a severe hyperthermia and central nervous system dysfunction resulting from strenuous physical activity.
• EHS can affect young, healthy individuals even in temperate climates due to a failure in thermoregulation.
• Increasing global temperatures and endurance event participation are linked to a rise in EHS cases.

Purpose of the Study:

• To provide intensivists with practical guidance on the pathophysiology, diagnosis, and management of exertional heat stroke.
• To emphasize the critical role of intensivists in early intervention and improving patient outcomes for EHS.
• To highlight the importance of awareness and preparedness in managing the growing incidence of EHS.

Main Methods:

• This review synthesizes current knowledge on EHS pathophysiology and clinical management.
• It focuses on diagnostic criteria and emphasizes immediate cooling strategies.
• The review discusses in-hospital care, including managing complications and supportive treatments.

Main Results:

• Early recognition and rapid cooling, particularly whole-body cold-water immersion, are crucial for survival.
• The "cool first, transport second" approach is essential for effective EHS management.
• Prompt in-hospital care is necessary to manage potential multi-organ complications.

Conclusions:

• Intensivists play a pivotal role in reducing EHS morbidity and mortality through timely intervention.
• Effective management requires a thorough understanding of EHS pathophysiology and prompt application of cooling therapies.
• Increased awareness and preparedness are essential to address the rising incidence of exertional heat stroke and improve patient outcomes.