What every intensivist should know about exertional heat stroke

Abstract

Exertional heat stroke (EHS) is a life-threatening condition caused by strenuous physical activity, leading to severe hyperthermia and central nervous system dysfunction. Unlike classic heat stroke, EHS can occur in young, healthy individuals and in temperate climates, when heat production exceeds the body's ability to dissipate heat. Rising global temperatures and increased participation in endurance events are contributing to a growing incidence of EHS. Early recognition and rapid cooling are essential to prevent multi-organ failure and death. Whole-body cold-water immersion is the gold standard treatment, and the principle of "cool first, transport second" is key to improving survival. In-hospital care focuses on continued cooling when necessary and managing complications such as acute kidney injury, coagulopathy, liver dysfunction, and neurological impairment. This review provides intensivists with practical guidance on the pathophysiology, diagnosis, and management of EHS. Given their expertise in critical illness and involvement in prehospital and emergency care, intensivists play a pivotal role in early intervention and reducing morbidity and mortality. As EHS incidence rises, increased awareness and preparedness are essential to ensure timely, effective treatment and improve patient outcomes.

Keywords: Cold water immersion; Cooling techniques; Critical care; Emergency management; Exertional heat stroke; Heat illness management; Multi-organ dysfunction.