Cold-Water Immersion and the Treatment of Hyperthermia: Using 38.6°C as a Safe Rectal Temperature Cooling Limit

Gagnon, Daniel; Lemire, Bruno B.; Casa, Douglas J.; Kenny, Glen P.

doi:10.4085/1062-6050-45.5.439

Cited by 66 publications

(68 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For example, an individual wearing PADS during CWI with a T rec of 428C would require 4 minutes of additional cooling to reach the recommended T rec CWI removal temperature of 38.68C. 30 Thus, our current data confirmed the observation of Miller et al 17 that T rec cooling rates are still considered acceptable 9 when PADS are worn during CWI. Whereas football uniforms may be removed quickly in EHS scenarios, 16 the time needed to remove PADS is based on 5 assumptions: (1) trained individuals are present to remove PADS from AFPs with EHS, (2) the individuals treating the AFPs with EHS are familiar with PADS removal, (3) the PADS are removed easily, (4) the necessary tools for uniform removal are available, and (5) AFPs are compliant with medical personnel.…”

Section: -15supporting

confidence: 80%

Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Miller

Long

Edwards

2015

Journal of Athletic Training

View full text Add to dashboard Cite

Context: The National Athletic Trainers' Association and the American College of Sports Medicine have recommended removing American football uniforms from athletes with exertional heat stroke before cold-water immersion (CWI) based on the assumption that the uniform impedes rectal temperature (T rec ) cooling. Few experimental data exist to verify or disprove this assumption and the recommendations.Objectives: To compare CWI durations, T rec cooling rates, thermal sensation, intensity of environmental symptoms, and onset of shivering when hyperthermic participants wore football uniforms during CWI or removed the uniforms immediately before CWI.Design: Crossover study. Conclusions: Whereas participants cooled faster in NO pads , we still considered the PADS cooling rate to be acceptable (ie, .0.168C/min). Therefore, if clinicians experience difficulty removing PADS or CWI treatment is delayed, they may immerse fully equipped hyperthermic football players in CWI and maintain acceptable T rec cooling rates. Otherwise, PADS should be removed preimmersion to ensure faster body core temperature cooling.Key Words: clothing, equipment, exertional heat stroke, rectal temperature Key PointsBody core temperature decreased faster when participants wore undergarments, shorts, and crew socks than when they wore the full American football uniform (PADS) without shoes during cold-water immersion (CWI). If CWI is delayed or clinicians have difficulty removing PADS, they can immerse hyperthermic football players in PADS and maintain acceptable core temperature cooling rates. The PADS should be removed before CWI if that can be done properly, easily, and within 30 minutes of athlete collapse.A merican football players (AFPs) may be at higher risk of developing exertional heat stroke (EHS) in part because of the equipment-intensive uniform worn during the sport.1 These athletes compete and often practice while wearing a full uniform consisting of shoes; crew socks; undergarments; shorts; game pants; undershirt; shoulder pads; jersey; helmet; and padding over the thighs, knees, hips, and tailbone (PADS).2,3 The increased metabolic demand and physiologic strain of exercising while wearing PADS, combined with a decreased evaporative surface area to dissipate heat, can result in substantial heat storage 2-5 and may contribute to the development of exertional heat illness. In fact, the rate of exertional heat illness in secondary school AFPs is 11 times higher than that in all other sports combined. 6 If EHS develops and body core temperature stays above the critical threshold for cell damage (approximately 40.58C) longer than 30 minutes, the risk of morbidity and mortality increases. 7,8 Therefore, it is paramount to develop efficient protocols for treating AFPs with hyperthermia.The criterion standard treatment for EHS is cold-water immersion (CWI) because of its superior cooling rates (ie, .0.168C/min) 7,9 and high survival rates when implemented shortly after the onset of symptoms.

show abstract

Section: -15supporting

confidence: 80%

Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Miller

Long

Edwards

2015

Journal of Athletic Training

View full text Add to dashboard Cite

show abstract

“…Numerous position statements 2,3,8 and experts 4,25,26 have advocated for T rec assessment as a vital component of proper EHS diagnosis and management. However, no evidence-based recommendation regarding how far clinicians should insert a rectal thermistor when EHS is suspected has been provided.…”

Section: Discussionmentioning

confidence: 99%

“…36 The differences in cooling rates between T eso and T rec may have clinical implications. Current recommendations are to use T rec to make clinical judgments on CWI cessation 26 and EHS diagnosis. 2,3,8 Though T eso may indicate a patient's T core has returned to safe levels, considerable heat stress still exists as indicated by the high T rec .…”

mentioning

confidence: 99%

Validity of Core Temperature Measurements at 3 Rectal Depths During Rest, Exercise, Cold-Water Immersion, and Recovery

Miller

Hughes

Long

et al. 2017

Journal of Athletic Training

Self Cite

View full text Add to dashboard Cite

Context: No evidence-based recommendation exists regarding how far clinicians should insert a rectal thermistor to obtain the most valid estimate of core temperature. Knowing the validity of temperatures at different rectal depths has implications for exertional heat-stroke (EHS) management.Objective: To determine whether rectal temperature (T rec ) taken at 4 cm, 10 cm, or 15 cm from the anal sphincter provides the most valid estimate of core temperature (as determined by esophageal temperature [T eso ]) during similar stressors an athlete with EHS may experience.Design: Cross-sectional study. Setting: Laboratory.Patients or Other Participants: Seventeen individuals (14 men, 3 women: age ¼ 23 6 2 years, mass ¼ 79.7 6 12.4 kg, height ¼ 177.8 6 9.8 cm, body fat ¼ 9.4% 6 4.1%, body surface area ¼ 1.97 6 0.19 m 2 ). Intervention(s): Rectal temperatures taken at 4 cm, 10 cm, and 15 cm from the anal sphincter were compared with T eso during a 10-minute rest period; exercise until the participant's T eso reached 39.58C; cold-water immersion (~108C) until all temperatures were 388C; and a 30-minute postimmersion recovery period. The T eso and T rec were compared every minute during rest and recovery. Because exercise and cooling times varied, we compared temperatures at 10% intervals of total exercise and cooling durations for these periods.Main Outcome Measure(s): The T eso and T rec were used to calculate bias (ie, the difference in temperatures between sites).Results: Rectal depth affected bias (F 2,24 ¼ 6.8, P ¼ .008). Bias at 4 cm (0.858C 6 0.788C) was higher than at 15 cm (0.658C 6 0.688C, P , .05) but not higher than at 10 cm (0.758C 6 0.768C, P . .05). Bias varied over time (F 2,34 ¼ 79.5, P , .001). Bias during rest (0.428C 6 0.278C), exercise (0.238C 6 0.538C), and recovery (0.658C 6 0.358C) was less than during cooling (1.728C 6 0.658C, P , .05). Bias during exercise was less than during postimmersion recovery (0.658C 6 0.358C, P , .05).Conclusions: When EHS is suspected, clinicians should insert the flexible rectal thermistor to 15 cm (6 in) because it is the most valid depth. The low level of bias during exercise suggests T rec is valid for diagnosing hyperthermia. Rectal temperature is a better indicator of pelvic organ temperature during cold-water immersion than is T eso .

show abstract

“…around the top of the head will enhance rapid cooling further. 45 It is recognized that cold water is not always available in remote areas. One alternative, when resources are limited, is to douse the victim with immediately available water.…”

Section: Coolingmentioning

confidence: 99%

“…9 The most important determinant in an EHS outcome is the amount of time that patients' core body temperature is above the threshold (38.6°C) for cellular damage. 45 Reducing the T core to less than 40°C within 30 minutes or less is critical. 6 When in doubt, the maxim "cool first, transport second" should be employed to ensure rapid treatment.…”

Section: Coolingmentioning

confidence: 99%

Exertional Heat Stroke in Navy and Marine Personnel: A Hot Topic

Goforth

Kazman

2015

Critical Care Nurse

View full text Add to dashboard Cite

Although exertional heat stroke is considered a preventable condition, this life-threatening emergency affects hundreds of military personnel annually. Because heat stroke is preventable, it is important that Navy critical care nurses rapidly recognize and treat heat stroke casualties. Combined intrinsic and extrinsic risk factors can quickly lead to heat stroke if not recognized by deployed critical care nurses and other first responders. In addition to initial critical care nursing interventions, such as establishing intravenous access, determining body core temperature, and assessing hemodynamic status, aggressive cooling measures should be initiated immediately. The most important determinant in heat stroke outcome is the amount of time that patients sustain hyperthermia. Heat stroke survival approaches 100% when evidence-based cooling guidelines are followed, but mortality from heat stroke is a significant risk when care is delayed. Navy critical care and other military nurses should be aware of targeted assessments and cooling interventions when heat stroke is suspected during military operations. (Critical Care Nurse. 2015;35[1]:52–59)

show abstract

Cold-Water Immersion and the Treatment of Hyperthermia: Using 38.6°C as a Safe Rectal Temperature Cooling Limit

Abstract: Immersion for approximately 9 minutes to a rectal temperature cooling limit of 38.6°C negated any risk associated with overcooling hyperthermic individuals when they were immersed in 2°C water.

Cited by 66 publications

References 31 publications

Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Validity of Core Temperature Measurements at 3 Rectal Depths During Rest, Exercise, Cold-Water Immersion, and Recovery

Exertional Heat Stroke in Navy and Marine Personnel: A Hot Topic

Contact Info

Product

Resources

About