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Practice Guideline
. 2025 Feb 1;53(2):e490-e500.
doi: 10.1097/CCM.0000000000006551. Epub 2025 Feb 21.

Society of Critical Care Medicine Guidelines for the Treatment of Heat Stroke

Jeffrey F Barletta  1 , Tina L Palmieri  2 , Shari A Toomey  3 , Fayez AlShamsi  4 , Rebecca L Stearns  5 , Asad E Patanwala  6 , Nicole F Siparsky  7 , Neeraj Badjatia  8 , Brian Schultz  9 , Crystal M Breighner  10 , Eric Bruno  11 , Christopher G Harrod  12 , Tanya Trevilian  13 , Leandro Braz de Carvalho  14 , James Houser  15 , John M Harahus  16 , Yang Liu  17 , Ryan Swoboda  18 , Paulin Ruhato Banguti  19 , Heatherlee Bailey  20
Affiliations
Practice Guideline

Society of Critical Care Medicine Guidelines for the Treatment of Heat Stroke

Jeffrey F Barletta et al. Crit Care Med. .

Abstract

Rationale: Predicted increases in heat-related weather phenomena will result in increasing heat exposures and heat injuries, like heat stroke. Prompt recognition, early intervention, and evidence-based management are necessary to optimize outcomes.

Objectives: The objective of these guidelines was to develop evidence-based recommendations for the treatment of patients with heat stroke.

Design: The Society of Critical Care Medicine convened a multidisciplinary panel of 18 international clinicians, comprising expertise in critical care, emergency medicine, neurocritical care, surgery, trauma/burn surgery, sports medicine, athletic training, military medicine, nursing, pharmacy, respiratory therapy, and one patient representative. The panel also included a guidelines methodologist specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guidelines development including panel selection and voting.

Methods: The panel members identified Patient, Intervention, Comparison, and Outcomes questions in two main areas: cooling modalities and medications that affect temperature. A systematic review for each question was conducted to identify the best available evidence, statistically analyze the evidence, and assess the certainty of the evidence using the GRADE methodology. The GRADE evidence-to-decision framework was used to formulate the recommendations. Good practice statements were included to provide additional clinical guidance.

Results: The panel generated two strong recommendations, five good practice statements and one "only-in-the-context of research" statement. Active cooling measures are recommended over passive cooling methods, with cold- or ice-water immersion achieving the fastest cooling rate. This method should be prioritized where available. In heat stroke patients, there is no evidence to support pharmacological interventions that affect temperature control and they should be avoided.

Conclusions: The guidelines task force provided recommendations for the management of patients with heat stroke. These recommendations should be considered along with the patient's clinical status and available resources.

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Conflict of interest statement

Dr. Barletta is a consultant for Wolters Kluwer and a current member of Council for the Society of Critical Care Medicine. Dr. Stearns is employed by the Korey Stringer Institute, member of the USA Football Medical Advisory Panel, and received royalties as book editor for two books that contain material on heat illness. Dr. Siparsky received funding from UpToDate. Dr. Schultz disclosed government work; he is a U.S. Government employee. Dr. Bruno received funding from Hemcon. Dr. Bailey received funding from Radiometer and Baxter; she disclosed that she is a past President of the Society of Critical Care Medicine. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. National Weather Service/National Oceanic and Atmospheric Administration: Weather Related Fatality and Injury Statistics. 2023. Available at: weather.gov/hazstat. Accessed August 15, 2024
    1. Chestovich PJ, Saroukhanoff RZ, Moujaes SF, et al.: Temperature profiles of sunlight-exposed surfaces in a desert climate: Determining the risk for pavement burns. J Burn Care Res. 2023; 44:438–445
    1. Douma MJ, Aves T, Allan KS, et al.; First Aid Task Force of the International Liaison Committee on Resuscitation: First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Resuscitation. 2020; 148:173–190
    1. National Emergency Medical Services Information System: Heat-Related EMS Activation Surveillance Dashboard. 2024. Available at: https://nemsis.org/heat-related-ems-activation-surveillance-dashboard/. Accessed August 15, 2024
    1. Bouchama A, Abuyassin B, Lehe C, et al.: Classic and exertional heatstroke. Nat Rev Dis Primers. 2022; 8:8

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