Exertional and classic heat stroke: A narrative review

Exertional (EHS) and classic heat stroke (CHS) share similarities in pathophysiology, progression, and potential sequelae. Further, quick recognition and management demonstrate favorable outcomes. Limited publications have examined parallels between types of heat stroke. Therefore, the purpose of this review was to search available literature and critically outline current evidence-informed clinical management of heat stroke. Our result was a thorough search and analysis of related literature that answers questions related to heat stroke. The pathophysiology of heat stroke is similar between EHS and CHS, with the only difference being onset predisposition and typical affected population. The main driver toward EHS includes exercise intensity inconsistent with environmental demands. CHS often presents in geriatric or pediatric populations and in patients with predisposing thermoregulatory limitations. Although debate continues in diagnostic criteria, both EHS and CHS are diagnosed with concomitant hyperpyrexia and central nervous system dysfunction. Following initial onset, the progression of cell death, tissue and organ failure, and potentially fatal outcome remains consistent between EHS and CHS. Emergency management of EHS has resulted in 100% survival when prompt diagnosis and effective treatment are administered. Results are not as favorable with CHS, albeit with a lack of robust data. The available evidence suggests similar management protocols would potentially improve outcomes with CHS. A potential addition to successful cooling may include hemodynamic support. Lastly, recommendations for enhanced data and documentation for heat stroke in emergency management could help foster consistent, updated clinical guidelines.