The “Golden Hour” for Heatstroke Treatment

Heled, Yuval; Rav, Moshe; Shani, Yoav; Epstein, Yoram; Moran, Daniel S.

doi:10.7205/milmed.169.3.184

Cited by 96 publications

(72 citation statements)

References 10 publications

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“…3,12,13,16 We demonstrated that the CS treatment produced faster cooling rates than no treatment; however, the rate of cooling was slower than that produced by currently recommended techniques. 3 We analyzed temperature responses to the treatment protocols using both T re throughout treatment and overall cooling rates.…”

Section: Discussionmentioning

confidence: 84%

“…13 The authors 13 attributed this difference to insufficient coverage of the first patient with water. Heled et al 12 doused patients with cold water and implemented intravenous infusion. This method demonstrated a cooling rate of only 0.058C/min.…”

Section: Discussionmentioning

confidence: 99%

“…One such case report 12 demonstrated cooling rates as low as 0.0448C/min during continuous water splashing. Even with the addition of fanning or an intravenous fluid infusion, cooling rates varied considerably from acceptable (0.088C/min-0.158C/min) to unacceptable (,0.088C/min).…”

mentioning

confidence: 99%

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Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

Butts

McDermott

Buening

et al. 2016

Journal of Athletic Training

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Context: Exercise conducted in hot, humid environments increases the risk for exertional heat stroke (EHS). The current recommended treatment of EHS is cold-water immersion; however, limitations may require the use of alternative resources such as a cold shower (CS) or dousing with a hose to cool EHS patients.Objective: To investigate the cooling effectiveness of a CS after exercise-induced hyperthermia.Design: Randomized, crossover controlled study. Setting: Environmental chamber (temperature ¼ 33.48C 6 2.18C; relative humidity ¼ 27.1% 6 1.4%).Patients or Other Participants: Seventeen participants (10 male, 7 female; height ¼ 1.75 6 0.07 m, body mass ¼ 70.4 6 8.7 kg, body surface area ¼ 1.85 6 0.13 m 2 , age range ¼ 19-35 years) volunteered.Intervention(s): On 2 occasions, participants completed matched-intensity volitional exercise on an ergometer or treadmill to elevate rectal temperature to 398C or until participant fatigue prevented continuation (reaching at least 38.58C). They were then either treated with a CS (20.88C 6 0.808C) or seated in the chamber (control [CON] condition) for 15 minutes.Main Outcome Measure(s): Rectal temperature, calculated cooling rate, heart rate, and perceptual measures (thermal sensation and perceived muscle pain).Results: The rectal temperature (P¼ .98), heart rate (P¼ .85), thermal sensation (P ¼ .69), and muscle pain (P ¼ .31) were not different during exercise for the CS and CON trials (P . .05). Overall, the cooling rate was faster during CS (0.078C/min 6 0.038C/min) than during CON (0.048C/min 6 0.038C/min; t 16 ¼ 2.77, P ¼ .01). Heart-rate changes were greater during CS (45 6 20 beats per minute) compared with CON (27 6 10 beats per minute; t 16 ¼ 3.32, P ¼ .004). Thermal sensation was reduced to a greater extent with CS than with CON (F 3,45 ¼ 41.12, P , .001).Conclusions: Although the CS facilitated cooling rates faster than no treatment, clinicians should continue to advocate for accepted cooling modalities and use CS only if no other validated means of cooling are available.Key Words: heat stress, exertional heat illness, whole-body cooling, water dousing Key PointsThe use of a cold shower to treat exertional hyperthermia was more effective than no treatment. The cooling rates elicited via the cold shower technique were deemed unacceptable when compared with the goldstandard treatment of cold-water immersion. Clinicians should continue to advocate for appropriate cold-water immersion resources. However, if cold-water immersion is not available, the cold shower technique should be used to treat patients with exertional heat illness as a last resort.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

Butts

McDermott

Buening

et al. 2016

Journal of Athletic Training

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“…Golden-hour subsumes time to reach definitive-care, thereby including communication/accessibility/reporting time, doctor-patient interaction time and stabilization-time allowing critical clinical interventions. Significant associations with deterioration of patient's condition have been found with each incremental minute of patient arrival to definitive-care [6][7][8][9]. It is important to note that doctor-patient interaction time and stabilization-time may be as long as 27.55 minutes, which may nudge into the golden-hour [10].…”

Section: Public Health and Epidemiologymentioning

confidence: 99%

“…Sometimes, visit come at the cost of leaving the medical facility without a doctor. In any resource limited scenario, most patients who deserve time, access definitive-care beyond the golden-hour [7,8,25,26].…”

Section: Public Health and Epidemiologymentioning

confidence: 99%

Operations Throughput as a Determinant of Golden-Hour in Mass-Gathering Medicine

Khan¹,

Asima

Khan

2017

IJMMR

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A novel indicator for temperature control in heat stroke treatment

Feng,

Tang,

Gong

et al. 2024

Precision Medical Sciences

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BackgroundTemperature control plays a pivotal role in patients with heat stroke (HS), but little work has been done sufficiently on the use of temperature control to reflect disease progression. Here, we defined and analyzed the concrete role of controlling time for core temperature to physiological level (CTTP), in order to explore a potential index to guide the treatment of HS.MethodThis is a retrospective cohort study. From three hospitals located in Sichuan province, China, we collected a total of 179 HS cases with clinical diagnosis and treatment records. We defined CTTP as the time interval of HS onset to stabilization of core temperature (rectal temperature) below 37.7°C and analyzed the correlation between CTTP and inpatient death of HS patients.ResultsOf all the cases, 64.80% were male and 53.07% were exertional heat stroke (EHS). The median (IQR) age was 59 (23.5–73) years old, and the median (IQR) onset temperature was 42 (40.4–42)°C. Multivariable analysis demonstrated significantly high inpatient death in the highest CTTP tertile (>18 h) (hazard ratio: 18.75; 99% confidence interval: 4.06–86.59; p = .0002). In addition, compared with patients in lowest CTTP tertile, patients in highest CTTP tertile were at significantly higher risk of organ damage: 3.48‐fold for respiratory failure (95% CI: 1.41–8.59, p = .0069); 3.18‐fold for shock (95% CI: 1.37–7.39, p = .0071); 4.09‐fold for rhabdomyolysis (95% CI: 1.73–9.64, p = .0013); 4.64‐fold for renal damage (95% CI: 2.12–10.14, p = .0001).ConclusionLong of CTTP predicts inpatient death of HS patients with a CTTP tertile >18 h associated with the highest rate of inpatient death.

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The “Golden Hour” for Heatstroke Treatment

Cited by 96 publications

References 10 publications

Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

Operations Throughput as a Determinant of Golden-Hour in Mass-Gathering Medicine

A novel indicator for temperature control in heat stroke treatment

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